The newly made mother is interested in literally everything about her baby: who does he look like, what is his weight and is everything all right with his health. It is not surprising that incomprehensible digits in the exchange card with an even more incomprehensible prefix “on the Apgar scale” cause questions in the woman in labor. What does the Apgar scale mean and why are grades given to a baby at such a tender age?
Indeed, even before the child receives his first grade at school, he is already awarded points from 0 to 10. This happens before nowhere - in the first and fifth minutes of life. And although this assessment is intended primarily for medical personnel, close ones of the baby will also not be amiss to find out what the Apgar scale is.
What it is?
What is the Apgar scale ? This is a unified system for assessing the condition of the newborn in the first minutes of his life. Important advantages of this system: it is extremely objective and will allow the medical staff to orient as quickly as possible if any particular baby needs urgent procedures. At present, Apgar grades are used almost all over the world.
A bit of history: who is Virginia Apgar
Virginia Apgar, the anesthesiologist, invented this assessment system, the only woman to become an honorary member of three American societies at once: pediatricians, obstetricians and anesthetists.
Virginia Apgar was born on June 7, 1909 in New Jersey, USA. Her father was Charles Emory Apgar (Apgarian), an eccentric Armenian inventor, fond of the natural sciences, astronomy and music. Mother - Helen - Irish by birth, was responsible in the family for strict education and discipline. Virginia was very friendly with her father, in their house there was a basement in which they constantly invented and constructed something. Thanks to the influence of her father, as a child, the girl played many stringed instruments, such as a cello, violin, knew many constellations and grabbed all the knowledge on the fly.
The family lived in poverty, but it was very tight when their son Lawrence fell ill with tuberculosis. And without that, a modest income went to the expensive treatment of the boy, but alas, at that time medicine had not yet advanced as far as now: the child was dead. It was this event that influenced the whole future life of Virginia, and she firmly decided to become a doctor.
In 1929, she won a scholarship competition at Columbia University. Soon after, the country is covered by the Great Depression, and in order to survive, the girl earns money at the most unskilled jobs in laboratories. In 1933, at the time of graduation from Virginia University, a truly astronomical debt of $ 4,000 had accumulated behind it - an unbearable amount for those times.
After graduation, Apgar gets a job at the Department of Surgery and quickly reaches certain heights. At that time, there were practically no anesthetists, and Virginia was trying to occupy this niche. A few more years of study - and now in 1939 she became the first female doctor with a diploma of an anesthesiologist. The feedback from colleagues about her has always been extremely positive: they noted her perseverance, efficiency and craving for knowledge. With such data, it was not difficult for her to become the head of the anesthesiology department at the surgery department.
In 1952, she introduced the world to her brainchild: her own scale developed by her. Consider what the Apgar scale is and what indicators it includes:
- Appearance - the color of the skin.
- Pulse (Heart Rate) - the pulse of the child (heart rate).
- Grimace (Response to Stimulation) - reflexes.
- Activity (Muscle Tone) - activity of movements, muscle tone.
- Respiration - breathing movements.
This is what the Apgar scale is. She evaluates the health of a newborn by five indicators: skin color, pulse, reflexes, activity and breathing.
Criterion A: skin color
Skin color can tell a lot about a newborn. The norm is everything between pale pink and bright pink. If the baby is blue, then this indicates a possible hypoxia. This parameter is estimated as follows: all shades of pink - two points; the presence of a bluish tint on the arms or legs - one point; excessive pallor or cyanosis - 0 points.
Criterion P: pulse
In newborns, the heartbeat is more rapid than in adults - an average of 120-150 beats per minute. If a tiny heart taps 100 times per minute or more, then doctors give the highest mark - two points. There are times when in the case of oxygen starvation, the pulse is intermittent - this is one point. Zero points will be given to the crumbs if there is no heartbeat.
Criterion D: reflexes
This parameter checks the child's innate unconditioned reflexes - screaming, coughing, sneezing. Normally, in order to get his two points, the baby should: let out his first scream, have a sucking reflex, sneeze when irritated. One point is a mild grimace on irritants. And zero points - if there is no manifestation of congenital reflexes.
Criterion A: Activity
Activity, or else muscle tone - these are the movements that the baby makes. In the womb, he was in a bent position: his small arms were clenched into fists, his head was pressed to his chest, and his legs were bent at the joints. Breaking free, the little man involuntarily checks what his limbs and joints are capable of. The better he gets it, the higher the score he gets - two points if the movements of the limbs are chaotic but active; one point - if the movements are sluggish and slow, and zero points - if there are no signs of at least some movement
Criterion P: respiration
The most important thing a baby should do after birth is to learn to breathe on its own. This is the last Apgar criterion. Normally, in order to earn his highest two points, a little man must make 40-45 respiratory movements per minute, and when he is born, scream loudly. A mark of one point is set if breathing is slow, irregular, the baby copes with its task with difficulty, and when you inhale the baby makes sounds that resemble a moan. Zero points is the complete absence of screaming and breathing.
Apgar scale: transcript
The Apgar score is always double, for greater reliability, all five indicators are checked by doctors twice - in the first minute and in the second. Therefore, the extracts always contain fractional numbers: 7/8, 9/9, 9/10. Most often, the second digit is higher than the first, because the baby is adapting to our world every second, and positive dynamics is the norm of a healthy, properly developing baby. Lack of progress implies increased attention of doctors. If a baby was born as a result of premature birth, it is evaluated on a Apgar scale three times.
Are foreign children healthier?
Interestingly, according to statistics in Western countries, infants more often receive their 10 out of 10 on the Apgar scale. So what is it, are these kids healthier? Not at all, most often here our mentality comes into force. If you do not consider children who really have some problems at birth, our children are no different in health from those born in other countries.
The fact is that our doctors are sometimes afraid to give the highest score, motivating the Russians "so as not to jinx it." Therefore, most often in the exchange card, women in labor will be 9/10, while the doctor will boldly put 10 out of 10 for exactly the same baby with identical indicators, for example in Europe. Fortunately and for the calmness of mothers, this trend is passing in Russia.
Features of the Apgar scale for cesarean section
Pediatricians note a small pattern in the assessments of children who were born through surgery, and not in a natural way. The most common score for children born as a result of cesarean section is 8/9. Neonatologists attribute this to the fact that such babies did not experience stress and did not experience hypoxia, passing through the birth canal.
Features of the Apgar scale in assessing premature babies
The discussion on the appropriateness of using the Apgar score for prematurity in case of prematurity is not currently closed. A number of scientists believe that in the case of preterm birth, this scale is incorrect to use, because some indicators, such as skin color, muscle tone and response to stimulus depend on the physiological maturity of the baby.
In the case of the birth of a premature baby, the results are dubious, because the baby has not yet “ripened”. In 1996, it was suggested that the Apgar scale cannot be used as the only test for the presence of hypoxia in a child, and at the moment other symptoms, for example, cerebral status, blood pH, etc., are taken into account.
Features of the Apgar scale when evaluating twins and triplets
With a multiple pregnancy, Apgar scores are usually lower than with a singleton.
This pattern has a number of explanations: high risk of complications, early birth (twins are usually born at 36-37 weeks, and triplets at 34-35th), low body weight of newborns, low muscle tone.
Apgar Baby Score
Many mothers, having received a low rating, begin to get nervous: what if something is wrong with their child? What does the Apgar score mean, is this not an indication of future problems? But here you need to clearly understand: the Apgar scale is not the ultimate truth, but only preliminary, very first data. Moreover, the Apgar scale does not evaluate anything other than a physical condition, it is impossible to judge a mental state using this technique. The indicators are taken in the first and fifth minutes of life, and if doctors evaluated the same child for the tenth or thirtieth minute, in most cases the estimates would have been even greater.
Indicators
It is logical that the higher the indicators, the healthier the newborn. Anything above grade 7 is the norm. That is, the norm is 7/7, and 8/9, and 7/10. The most common indicator is 8 points on the Apgar scale.
If the number of points scored ranges from 4 to 6, then this condition is assessed as satisfactory, but with a slight deviation from the norm, additional thorough observation is required. Such ratings are often given to premature babies.
From 3 to 4 - health at birth is poor, the probability of resuscitation is high, strict monitoring of medical staff is needed
From 0 to 2 - extremely low viability indicators, critical condition and the need for urgent resuscitation. This is already about the life of a little man, in the future, children with such low grades are necessarily observed by a number of specialists. Such is the decoding on the Apgar scale.
Can mom help her baby get a higher grade?
What does Apgar score mean for a future mother? Is she able to somehow influence them? Not just capable, but a must. As soon as the pregnancy test shows two strips, and in the antenatal clinic they announce that a new life has arisen inside, it is necessary to completely reconsider your priorities. The full development of the fetus depends on the nutrition of the expectant mother during pregnancy, following the instructions of her doctor, the absence of bad habits, a healthy lifestyle and daily routine. The right approach to pregnancy will help give birth to a strong and healthy baby.
The state on the Apgar scale also depends on the behavior of the woman in labor during labor. You can’t ignore the words of obstetricians. So, for example, if it is wrong to push, then the baby may be born with a bluish skin color instead of natural pink. In the future, everything will return to normal, but at the time of birth, the baby on the Apgar scale will receive a rating lower.
In conclusion: the importance of the Apgar scale
Some mummies say that the Apgar scale for newborns is comparable in importance to the singing diploma in the 3rd grade: at a particular moment, this is important and prestigious, but it does not matter much for later life. In fact, only pediatricians and parents themselves are interested in points; in adulthood, they have no more significance than growth and weight indicators at birth. There is no reason to panic if the indicators were lower than expected. Often children with low grades are no different from their peers with high scores after a couple of weeks of life, not to mention years. And, of course, the Apgar scale is not at all an indicator of what talents are hidden in a small squealing baby.