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24/05/2004
The Apgar score: history and usefulness
More than 50 years after
its introduction in the clinical practise, the Apgar score
remains the first and most important test to quickly evaluate
a newborn's physical conditions.
The Apgar score is the
very first test given to the infant at birth. It was developed
in 1952 by Virginia Apgar, an anesthesiologist- neonatologist,
to quickly evaluate a newborn's physical conditions. She created
this scoring system to helps physician to identify babies
at risk for complications or bad outcome from delivery.
For this reason, it was
designed to be simple, repeatable and predictive.
The Apgar test is usually
given to the newborn twice: once at 1 minute after
birth and again at 5 minutes after birth.
It can be repeated for
a third time at 10 minutes after birth if the infant
has serious clinical problems.
The baby is rated on a
scale of zero to two on each of the following signs:
- A
- appearance
- P
- pulse
- G
- grimase
- A
- activity
- R
- respiration
Each characteristic is given an individual
score; then all scores are added up.
| Apgar signs |
2 |
1 |
0 |
| Appearance (skin coloration) |
Normal color all over
(hands and feet are pink) |
Normal color all over
(but hands and feet are bluish) |
Bluish-gray or
pale all over |
| Pulse (heart rate) |
Normal (above 100
bates per minute) |
Below 100 bates
per minute |
Absent (no pulse) |
| Grimace (reflex irritability) |
Pulls away, sneezes,
or coughs with stimulation |
Facial movement only
(grimace) with stimulation |
Absent (no response
to stimulation) |
| Activity (muscle tone) |
Active, spontaneous
movement |
Arms and legs flexed
with little movement |
No movement, floppy tone |
| Respiration (rate and effort) |
Normal rate
and effort |
Slow or irregular
breathing |
Absent (no breathing) |
As you can see, 10 is the
highest possible score.
Anyway, most newborn never
receive it because the hands and feet of healthy babies are
usually still slightly bluish and not yet pink at 5 minutes
after birth.
An infant who scores a
7 or above on the test at 1 minute after birth is generally
considered in good health.
Those who score between
5 and 7 are in fair condition and may require some help breathing.
A newborn with an Apgar
score less than 4 generally requires advanced medical care
and emergency measures, like assisted breathing, administration
of fluids or medications and observation in a neonatal intensive
care.
Tthe Apgar score cannot
predict long term neurologic impairment, although one time
some experts thought it. One theory suggested that newborn
whose scores remained low at the five-minute mark were likely
to develop neurological diseases.
Recent studies proved that
idea was false; however, it remains of paramount importance
for the clinical evaluation at birth.
Conclusions
The
Apgar test is even today a useful tool to predict short-term
outcome.
It's still very important for its properties to evaluate
immediately the clinical conditions of the newborns and,
therefore, to help the neonatologist to plan the proper
therapy.
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