APGAR Score

What’s Apgar Score.

APGAR score is a grading system developed in 1952 by a Doctor known as Virginia Apgar. As you can tell from the name, this scoring system was named after her.

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apgar scor

The APGAR scoring system was developed to help assess the well-being of an infant or a newborn after birth. As well all know, the process of birth can be traumatizing to the newborn, and sometimes the transition from uterine life to outside uterine life may have some glitches. Using this Apgar score helps in evaluating the infant. This is a popular score and has been used for a very long time with doctors and nurses all over the world.

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How APGAR score works.

There are 5 categories in the Apgar scoring system. An infant is placed or graded in each score depending on how well they are doing. In each category, points are awarded, the point is 0, 1, or 2 (0 being the lowest and 2 the highest).In total, the infant can score a maximum of 10 points, or a minimum of 0 points, depending on how well the infant performs. These categories are easy to remember because they use the mnemonic APGAR. These categories include Appearance, Pulse, Grimace, Activity, and Respiration.

Appearance
Here, we check the infant’s general body appearance and grade the as either being blue in color, pink with blue extremities, or completely pink. A baby having blue color means this infant does not have enough reaching their body tissues thus having the blue color. Remember that this is also what we call cyanosis, or in other words, we can say this baby is cyanotic. On the other hand, the one who is completely pink has adequate oxygen tissue perfusion and they are doing really well. In terms of appearance, the infant can score a zero if they are blue, 1 if they are pink with blue extremities, or lastly 2 if they are completely pink.

Pulse
Here we are checking for a pulse and counting the pulse rate per minute. In infants, the pulse rate per minute is usually higher than that of adults, reaching between 100 per minute to 160 per minute. In this category, we give 0 points to those with absent pulse rate, 1 to those with a respiratory rate of less than 100 per minute, and finally 2 points for those with more than 100 per minute. The popular place to check for the pulse rate in infants is the umbilical stump.

Grimace

In simple terms, we can say that grimace means response to stimulation.

Here, we want to check the baby’s grimace. We will check if the is no grimace, if they have grimace only after being stimulated, or if they are actively crying, sneezing, or even coughing. Those with absent response to stimulation receive 0 points, those with minimal response to stimulation are given 1 point and finally, those with prompt response to stimulation 2 points.

Appearance

In appearance, we will be observing the infant’s movements. Are they still with no movement? Are they having their limbs flexed? Are they actively moving their limbs and stretching their limbs?

Those with no movement are given 0 points. Those with flexed limbs are given 1 point, and those with active movements receive 2 points.

Respiration

Crying is a good indicator that can elicit if the respiration of an infant is good. Those with no cry or no evidence of respiration are given 0 points. Those who have an irregular weak cry receive 1 point, while those with a loud strong cry are given 2 points.

According to what an infant gets in their final score, they can be put into 3 groups. The first group is those having a score of between 7 – 10, there is a really reassuring and tell the doctor or nurse that the infant is doing well so far. The second group is those having a score of between 4 – 6, and these infants are doing moderately doing well, and a close eye is kept on them.

Those who have a score of between 0 – 3, are concerning, and are really not doing well. Assistance may be needed for these infants. This assistance includes;

  • Drying them with warm dry towels to try and stimulate them.
  • Sectioning of their mouth and nose, to dry and suck out any meconium.
  • Ensuring they are warm enough by removing any wet towels and putting them under a warmer.
  • Administration of oxygen to try and improve the oxygen saturation.
  • If all fails, they may need resuscitation.

The APGAR score is performed in the first 1 – 5 minutes to check those who are not doing well and may need further intervention. It will also be done after 10 minutes.

Doctors and nurses also know that some infants might need interventions and close monitoring. This is because some of these infants have risk factors that predispose them to get low Apgar scores at birth. These include

  • Premature infants.
  • Those who have had complicated deliveries.
  • Those who were born via cesarean section(CS).

Recommendations

  • You should keep in mind that we do not use the Apgar scoring system to predict the outcome of neonates, neurologically, or chances of their survival. It only acts as a guide to help us better manage the newborn.
  • It is best practice to always get the umbilical artery blood gas for those newborns who get an Apgar score of less than or equal to 5 at 5 minutes.
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AppearanceBluePink with blue extremitiesCompletely pink
PULSEAbsentLess than 100More than 100
GRIMACEFloppyMinimal response on stimulationPrompt response when stimulated
ACTIVITYAbsentFlexed limbsVery active
RESPIRATIONAbsentSlow and irregularActively and vigorously crying

Further Reading

  1. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score
  2. https://medlineplus.gov/ency/article/003402.htm

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