Apgar index: what it is for and how to evaluate the score
The "Apgar index, also known as" Apgar score ", is the result of a series of checks that are carried out on the newborn immediately after birth: the test - with consequent points evaluation system - is carried out precisely to evaluate the health of the child at birth.
This system thus allows to establish the vitality and efficiency of the newborn in its first minutes of extra-uterine life, once the pregnancy is over, as well as its ability to overcome the effort of childbirth itself. If the Apgar index shows a score in the normal range means that the child does not need further medical interventions and is fine.
The Apgar test, which serves to establish the score, is carried out within the first minute after birth to understand if the baby has reacted well, and then be repeated five minutes after birth: in this case it will provide valuable information on the ability to adaptation of the newborn to life outside his mother's womb.
As we will elaborate on later, the Apgar index takes into account five fundamental criteria: color, reflex excitability, muscle tone, respiratory activity and heart rate. Each of these criteria is scored at the end: if the index is low, it will be necessary to transfer the baby to neonatology for the necessary treatments.
Let's take a closer look at how this evaluation exam works, why it is called that, when and how it is carried out and how to evaluate the score obtained from the test. But first, enjoy this heartwarming video of a mom picking up her premature baby for the first time ... what a thrill!
What does "Apgar index" mean and why is it called that?
The Apgar index is named after Virgina Apgar, a physician from the United States who first introduced it in 1952. At that time it was very common for children to die after birth because doctors and nurses had not been able to identify respiratory problems. circulation, reactivity or more.
Thanks to the index devised by Virginia Apgar, however, a method was developed to evaluate the real health of children, even those who appeared healthy, but who in reality were not and needed urgent support for vital functions.
Later, pediatrician Joseph Butterfield used the letters of Virginia's surname to create an inverse acronym, which would allow medical students to better memorize the five criteria to be analyzed to evaluate the health of the newborn - an intelligent system still in use today. :
A → Appearence (complexion)
P → Pulse (heart rate)
G → Grimace (reflections)
A → Activity (muscle tone)
R → Respiratory effort
When and how is the test carried out?
The Apgar test is performed on the baby within the first minute of birth, and is then repeated five minutes later. In this period of time, in fact, the score can vary quite a lot. In children who are born by caesarean section, for example, there is often a low Apgar index at the beginning, due to the anesthetic that is administered to the mother and which - in small parts - also reaches the baby through the placenta. Repeating the test after 5 minutes, the score should be higher, normal.
As anticipated, this evaluation system is based on 5 parameters. The first is the heart rate, which is essential to understand if the child needs assistance or not. A regular heart rate in the newborn should be between 100 and 140 beats per minute. If the baby's heart rate is within the indicated parameters, he will be assigned a score of 2.If the value is below 100 beats per minute, he will receive 1 point. If there is no beat, the score will be 0.
The second criterion of the Apgar test is spontaneous respiratory activity: if the newborn will breathe normally and cry vigorously, he will be awarded 2 points. If he has apnea one minute after birth, he will be awarded 0 points. breathing will be slow or irregular, will have 1 point.
The third criterion is muscle tone: if the child is not very tonic or completely flaccid he will have 0 points, if he will move actively with a spontaneous flexion of the limbs he will receive 2.
The fourth criterion is that of reactivity to stimuli: the child will receive small stimuli (such as a small blow on the feet) to see if he reacts, observing in particular the contraction of the mimic muscles, sneezing and coughing. If he reacts to stimuli the score will be 2. If the reaction is absent, the score will be 0.
Finally, the last criterion, the most complex to evaluate: the complexion. The score of 2 will be assigned only if the newborn has a completely rosy complexion. He will receive 1 point, however, if his extremities tend to be bluish-purplish and 0 points if it is cyanotic or pale in color.
To calculate the Apgar index, at this point, it will be sufficient to add up all the scores attributed to the 5 criteria. The final score can range from 0 to 10. If the result is equal to or greater than 7, it means that the baby is healthy.
With a score below 4, the baby will need immediate medical attention. With a score between 4 and 6 he will be considered at risk, he will have to be assisted and repeat the test every 5 minutes. The test is carried out by the doctor or midwife present in the delivery room immediately after birth. It is usually carried out in a short time and without special tools.
For more information on the Apgar index, you can consult the website of the Bambino Gesù Hospital.
