Kaboni Whitney Gondwe

APGAR SCORING

OBJECTIVES
Overview of Apgar scoring Explain the significance and components of Apgar scoring

APGAR SCORING

The Apgar score was devised by Dr. Virginia Apgar in 1953 and is a commonly quantitative measure of neonates wellbeing at and around birth. The purpose of the Apgar score is to evaluate physical condition of the newborn at birth and the immediate need for resuscitation. The newborn is rated at 1minute and 5 minutes after birth and it gives a total score ranging from 0 to 10.

The 1 minute score indicates the degree of central suppression of the baby and is important for further management of resuscitation. The 5 minute score indicates the babys ability to adapt to extrauterine life and is also a reliable predictor of the risk of death during the first 28days of life and the child neurological state and risk of major disability at the age of 1 year. The higher the Apgar score the better the outcome of the baby.

The mnemonic for Apgar score is: A Appearance (i.e. color) P Pulse (i.e. heart rate) G Grimace (i.e. response to stimuli) A Active (i.e. tone) R Respirations

The five indicators used are; Heart rate: auscultate or palpate at the junction of the umbilical cord and skin. This is the most important assessment. A newborns heart rate of less than 100 beats per minute indicates need for immediate resuscitation Respiratory effort: second most important assessment. Complete absence is termed apnea and a vigorous cry indicates good respirations.

The muscle tone: evaluate the degree of flexion and resistance to straightening of the extremities. A normal term newborns elbows and hips are flexed, with the knees positioned up towards the abdomen. Reflex irritability: evaluate as the newborn is dried or by lightly rubbing the soles of the feet. A cry is a score of a 2 and a grimace is a 1 and no response is 0.

Skin color: inspect cyanosis and pallor. Newborns generally have blue extremities and the body is pink which merits a score of 1. This condition is termed acrocyanosis and is present in 85% of normal newborns at a 1 minute after birth. A completely pink newborn scores 2and a totally cyanotic, pale newborn score 0. Newborns with darker skin pigmentation will not be pink. Their skin color is assessed for pallor and acrocyanosis and a score is selected based on assessment.

Heart rate

0 Absent

1 Slow <100
Slow, irregular Some flexion of extremities Grimace

2 Fast >100
Good, crying Active motion

Respirator Absent y Rate Muscle Limp Tone

Reflex Irritability
Color

No response
Pale blue

Body pink, extremities blue

Vigorous cry, cough or sneeze Completely pink

A score of 8 to 10 indicates that the neonate is in good condition and requires only nasopharyngeal suctioning and perhaps some oxygen near the face. A score of 4 to 7 indicates the need for stimulation and a score under 4 indicate the need for resuscitation. The midwife should normally expect a score of about 9 in a normal term newborn due to acrocyanosis caused by poor peripheral circulation. However some Newborn can give a score of 10

YEBO