In the article, we will consider how the state of a newborn is assessed on the Apgar scale in obstetrics.
Immediately after birth, the obstetrician determines the basic indicators of the life support of the baby. This is necessary to understand the need for resuscitation and a general assessment of the vital parameters of the newborn. Such an assessment is an important aspect for further action by medical professionals. There is a single rating system, the so-called Apgar scale, which is used in many countries.
Algorithm
Assessing the condition of the newborn on the Apgar scale makes it possible to establish the vitality of the baby immediately after birth. This technique is more than 65 years old, it was developed by Virginia Apgar, an anesthetist from America. Moreover, the name of the scale itself has a double meaning. It not only contains the name of the person who developed the scale, but also the first letters of the main indicators translated into English, namely:
1. Appearance - a shade of the skin.
2. Puls - the frequency of contractions of the heart muscle.
3. Grimace - mimic congenital reflexes.
4. Activity - activity of muscle tissue.
5. Respiration - respiratory function.
Each indicator is evaluated according to a system of points from 0 to 2, which assume the following:
1. 0 - the absence of the evaluated characteristic.
2. 1 - weak severity of the evaluated criterion.
3. 2 - a pronounced criterion, the norm.
Points for all considered parameters are summarized. If the assessment of the condition of the newborn on the Apgar scale is low, specialists will decide on emergency care for the child, which may consist of transfusion procedures, mechanical ventilation, as well as placing the newborn in a special box that can support the vital functions of the body.
Assessment of the condition of the newborn on the Apgar scale is carried out immediately after the birth of the child in the first minutes of life. This is done in order to provide first aid if necessary. Next, the test is repeated after five minutes. In this case, the child’s ability to adapt to the new living conditions surrounding him is monitored.
All results are entered in a special table in the form of two columns of numbers, which can both differ (indicators of the second check are higher than in the first case), and remain unchanged. The resulting table is entered in the documents issued upon discharge of the child. They are used in the future by the district pediatrician to collect an anamnesis during the first year of a baby's life.
Consider the indicators for assessing the condition of the newborn on the Apgar scale.
Indicators for control
A newborn test on the Apgar scale should be carried out by a doctor. As a rule, the most important test parameter is the degree of oxygen starvation of the fetus. Inspection must be carried out very quickly, since significant deviations from normal values may require urgent action. In case of delay, we can talk about serious consequences for the health of the child and even his life. The main parameters of the norm in assessing the condition of the newborn on the Apgar scale are given below.
Respiratory function
The normal respiratory rate in a newborn is considered 40-45 times per minute. Crying is loud and audible. A decrease in score occurs if breathing is slow and uneven, and instead of a full-fledged scream, only trembling voice membranes are heard. In this case, the child is provided with additional oxygen through a special installation. A situation is considered critical when respiratory function is not observed, which requires urgent measures aimed at its restoration and connection to an artificial lung ventilation apparatus.
Heart muscle contraction rate
Immediately after the baby is born, the beating of his heart becomes more frequent, since when passing through the birth canal there is an increased load on the baby's body. If the heart rate is more than 100 beats per minute, namely 130-140, this indicates normal rates and a maximum rating on a scale. When oxygen intake into the child’s body is limited, respiratory function is suppressed, the heartbeat slows down to less than 100 beats per minute. In this case, the score is 1 point. The absence of heart contractions is indicated by a zero rating on a scale.
Muscle tone
This indicator in newborns is increased, and this is considered the norm. The fact is that during the period of gestation, the fetus is in one static position. After birth, freedom of the limbs appears, and the child randomly and abruptly moves his legs and arms, which indicates a good muscle tone. In some cases, doctors observe a grouping with legs and arms pressed tightly to the body, imitating a pose in the womb. One point speaks of the bent arms and legs of a child who occasionally makes small movements. Also, a low score indicates the absence or weak resistance when the doctor tries to move the child's limbs. If the activity of the movements is zero, points are not put.
Reflexes
Their unconditional variety should be present immediately after birth. This may be the first breath or scream, which is given the highest score. If the reflexes are late and appear as a response to resuscitation, one more is added to the total points. The complete absence of reflexes is indicated by a zero point.
Skin tint
The normal skin color of a newborn baby is pink. It is this shade that indicates the proper functioning of the circulatory system. As a rule, the correct shade of the skin is observed in children born by caesarean section, which is explained by the low probability of oxygen starvation, which often accompanies passage through the birth canal of the mother. A decrease in the rating on the scale occurs due to the detection in the newborn of a bluish tint on the feet and hands, as well as the mucous membrane of the oral cavity and lips. If a significant area of the child’s skin is bluish or pale blue, points are not awarded.
Deciphering the results
The maximum number of points a child can get on the Apgar scale is ten. Such an assessment is extremely rare, in only 10-15% of cases. A similar indicator for Apgar is considered a reference and is found even more rarely in our country, which is due to the level of health and mentality. Medical specialists abroad more often give similar assessments. In this case, a reason for reducing points can be found even in a completely healthy child, for example, with blueness of the hands or feet.
It should be borne in mind that the sum of the points obtained in assessing the condition of the newborn on the Apgar scale does not indicate a good or poor health status of the child, and is also not a characteristic of mental development or a method of diagnosis, it only indicates the infant's ability to live. If the result of the Apgar assessment does not approach zero, it cannot have an effect on the future health of the child. This express method allows you to diagnose the condition of the child at the time of verification, and also makes it possible to determine the need for urgent measures.
What, for example, does the Apgar score of 7 state of a newborn child mean? Risk groups will consider below.
Consider examples of ratings:
1.0-3, 3-3. The condition of the child is critical, severe asphyxia is observed, resuscitation measures are necessary.
2.4-5. In this case, monitoring of indicators in dynamics is required. Similar points indicate moderate asphyxiation.
3. 6-7. Asphyxia to a mild degree, there is no threat to the life of the child.
4. 7-7, 7-8. Medium level condition, close monitoring and control are not required.
5.8-8. The child’s health is assessed above average, a decrease in points occurs due to the fact that some aspects are weaker than others, but not critical.
6.8-9, 9-10. The condition of the child is assessed as good, all the reflexes and systems of the baby’s body are functioning normally.
If the rating is low
If the assessment of the condition of the baby immediately after birth is low, doctors begin to carry out resuscitation actions aimed at normalizing indicators. If after five minutes the rating on the scale does not increase to 6-7 points, further monitoring of the condition of the child is carried out until an optimal result is achieved. As a rule, 15 minutes is enough to get positive dynamics.
If the child's indicators do not exceed 6 points after 15 minutes, he is determined in stationary conditions. The discharge occurs after the condition of the newborn is stabilized. Disturbances in the functioning of the nervous system are eliminated after some time, even if the indicators on the scale are quite low.
Prematurity and risk groups in assessing the condition of the newborn on the Apgar scale
Most often, a low rating is given to children who lack oxygen. This condition can be caused by chronic hypoxia, malformations in the fetus, as well as the complicated course of the birth process.
Another reason for the low rating on the scale may be the prematurity of the fetus. The child is evaluated according to standard parameters, while the infant born prematurely cannot respond a priori to them. Therefore, the number of points for premature babies is often not more than six. You should not be afraid of such low indicators, they are not a criterion for assessing the state of health and development of the child as a whole.
Assessment of the condition of the child on the Apgar scale is mandatory.
Systemic abnormalities and pathologies are not detected through this check. This scale only allows you to assess the state of viability of the child at the time of birth. Further studies will be required to determine the health status of the infant.
We examined the algorithm for assessing the condition of the newborn on the Apgar scale.