What is the Apgar Test, and what is it for?
In 1952, a renowned American obstetric anesthesiologist, Dr. Apgar, designed and began to apply a method to assess the newborn’s condition after delivery. Since then, the so-called Apgar test has become widespread in many countries.
This test measures in a fast and straightforward way the adaptation and vitality of the baby after birth. Although it is not a perfect test, it is helpful to evaluate the newborn’s transition from the womb to the outside and to guide about the need for it or not for immediate medical care. However, the actions required in babies who have a frankly compromised state of health at the time of birth should not be postponed or delayed until the evaluation at the minute of life.
It is important to emphasize that the objective of this test is not to predict the child’s future health or other factors such as behavior, intellectual level, or long-term performance. Ultimately, there is no clear relationship between the Apgar score and the baby’s later neurodevelopment.
There is also no conclusive data on the implications of the test results in preterm infants.
Scores may be altered if the baby requires resuscitation, and these scores are not equivalent to those for spontaneously breathing infants.
How is the Apgar Test carried out?
The Apgar test is carried out at one minute of life and is carried out again at five minutes. The first result indicates how well the baby has tolerated the birth process, while the latter indicates whether she is evolving correctly. Sometimes, suppose the baby’s physical condition is problematic (for example, she has required resuscitation). In that case, it usually repeats at ten minutes of life, at fifteen and twenty minutes, depending on the response.
During the test, the following parameters are assessed:
Heart rate The speed at which the baby’s heartbeats is measured. There may be no heartbeat, less than a hundred beats per minute, or more than a hundred.
Breathing. The effort made by the child when breathing is measured. It may happen that he does not breathe or that the breathing is slow or irregular, that it is good, or that the cry is weak or vigorous.
Muscular tone. It is assessed based on the posture and movements of the baby. This can remain flaccid, have slightly bent limbs, or move actively.
Reflex irritability. Assess the newborn’s response and gestures to stimuli. There may be no response, that you grimace or that you withdraw vigorously.
Skin coloration. It may be pale or blue, pink, but blue at the extremities, or completely pink.
The Apgar test was developed in 1952 as a simple and repeatable method to assess a baby’s health immediately after birth quickly. Dr. Apgar, the creator of the test, believed that the same signs traditionally used by anesthesiologists to monitor the patient’s condition during surgery could assess the baby’s condition after birth and predict the likelihood of survival. The test is typically done one minute and five minutes after birth and can be repeated later if the score is still low. The Apgar score is calculated by evaluating the baby on five criteria on a scale of 0 to 2, then adding the five values obtained. The five criteria of the Apgar test are:
Appearance/complexion: Is the baby blue or pale all over, is the body pink, or is the baby blue on the limbs?
Pulse rate: Is the baby’s heart rate absent, slow (<100 beats per minute (bpm), or fast (> 100 bpm)?
Irritability reflex: Does the baby have no response to stimulation, grimace, and give a weak cry, or cry and pull away when stimulated?
Activity: Is the baby inactive, flexed (movement of the joints), or has flexed arms and legs that resist extension?
Respiratory effort: Is the baby breathing, has a weak or irregular respiratory effort, or is his cry loud?
Apgar Scoring System – Diagnosing Cerebral Palsy, HIE and Birth Injuries
What do the Apgar scores mean?
Scores 1-3 are critically low, 4-6 are below average, and 7+ are normal. A low score indicates that the baby is likely to need medical intervention; the lower the score, the more alert the medical team will be to the possibility of intervention. For example, a baby with a low score is more likely to need resuscitation than a high score. When a baby needs resuscitation, she needs help with her heart, blood pressure and needs help with breathing or co.
Begin to breathe. Some components of the Apgar score are subjective, and there are certainly cases where a score is high, but urgent medical treatment for the baby may be necessary.
If the score remains low later, such as 10, 15, or 30 minutes after birth, there is a risk of the child suffering long-term neurological damage, and there is also a small but significant increased risk of cerebral palsy. However, higher Apgar scores do not rule out the possibility that the baby may have a brain injury, such as hypoxic-ischemic encephalopathy (HIE). However, it is essential to remember that the purpose of the Apgar test is to determine whether a newborn needs immediate medical attention quickly; it was not designed to make long-term predictions regarding the baby’s health.
How are the results interpreted?
Each of the above parameters is evaluated on a scale from 0 to 2, and then all the points are added so that the final figure ranges between 0 and 10. As it is carried out twice, two numbers are obtained. For example, 8/9, of which eight would correspond to the result at the first minute of life and 9, at five minutes.