Every modern mother in labor knows that when recording the parameters of a born child, weight, height and the newborn’s Apgar score are used.

If everything is clear with the measurements of height and weight, then by what criteria is the mysterious assessment given?

An anesthesiologist from America, Virginia Apgar, has developed a special table to help her resuscitation students, which allows them to clearly determine the condition and viability of the baby in the first minutes of a child’s birth.

The purpose of the scale is to quickly assess the condition of a newborn child regarding the need for resuscitation measures.

What indicators are assessed?

The condition of the newborn on the Apgar scale is assessed according to five main criteria:

• Coloring of the skin of the body and limbs.

0 - Pale bluish color of the body and limbs.
1 - Partially bluish color of the limbs.
2 - Healthy pink color throughout the body.

• Heart rate per minute.

0 - Not present.
1 - Up to 100 beats per minute.
2 - 100 or more beats per minute.

• Reflexes.

0 - Does not respond.
1 - Weak reaction, sluggish movements, grimace on the face.
2 - Moves actively, coughs, sneezes, screams.

• Muscle tone.

0 - Absent, limbs hanging down.
1 - The tone is reduced, weak movements of the arms and legs are observed.
2 - The tone of the limbs is actively expressed, vigorously moves the arms and legs.

• Breath.

0 - Not breathing.
1 - Shallow, irregular breathing, weak cry, slow breathing.
2 - Breathes normally, screams loudly.

For each criterion, the obstetrician and neonatologist give the child 0, 1 or 2 points. The final figure is the sum of points for all parameters of the Apgar table.

The child's condition is assessed using the Apgar scale in the 1st minute after the birth of the fetus. The second point is the same parameters assessed at the 5th minute.

Sometimes, with very low indicators, doctors give a third estimate at the 10th minute of the newborn’s independent life. Parents are usually given a double score, for example 7/9.

A score of 3 or less on the scale indicates an unfavorable condition of the child and the need for special life support measures.

7 points and above – the child is normal, viable, and has a good chance of gradually adapting to independent life.

Decoding the Apgar scale

Assessing the condition of the newborn helps doctors, if necessary, quickly take measures to support the child’s life:

• From 0 to 2 points.

The child's viability is at risk. Immediate resuscitation measures are required.

When timely professional assistance is provided, the baby shows the best Apgar result 5 and 10 minutes after birth.

Subsequently, the baby will need more careful care and monitoring. However, it is believed that even “B” students are capable of becoming physically strong and smart children in the future.

This is how premature babies are usually assessed. If the condition does not improve in the 5th minute, resuscitation is required, as well as special attention and care in the first weeks of life.

The condition of the newborn is considered satisfactory. The baby will need close medical supervision in the first week of life.

If the condition at the 5th minute of life has improved to 7-8 points on the Apgar scale, then a stay in intensive care is not required.

Optimized assessment of child viability. The baby tolerated the birth well and is not at risk. Doctors only make sure that the process of feeding and weight gain improves.

If the mother has enough milk and the baby is gaining weight, then his condition is not in danger.

• 10 points.

Highest Apgar score. During natural childbirth, the child rarely receives the highest score in all respects.

An Apgar score of 9/9 is considered excellent. Russian doctors do not give 10 simply so as not to jinx it. In the reports of foreign obstetricians, you can often find the number 10.

It is believed that “caesareans”, under equal pregnancy conditions, may have a higher Apgar score, since they did not have to endure the stress associated with passing through the birth canal.

In 1963, pediatrician Joseph Butterfield used the letters of Virginia Apgar's surname as an abbreviation to better memorize the table of Apgar scores.

This mnemonic rule helps English-speaking specialists keep in mind all the columns of the Apgar table:

1. A ppearance – appearance.
2. P ulse – heart rate
3. G rimace – facial expression, reflexes.
4. A ctivity - movement.
5. R espiration – respiratory activity.

Acronyms of the same nature also exist among specialists in the German and Spanish language environment.

In American English, a neologism has appeared that deciphers the abbreviation APGAR - American Pediatric Gross Assessment Record (General American Pediatric Gross Assessment Record). We are, of course, talking about the newborn assessment system, famous among obstetrics all over the world.

In the English-speaking environment, there is also another principle of simplified memorization of Apgar scale data - H ow R eady I s T he C hild (how prepared the child is)

• H heart rate – heart rate.
• R espiratiry effort - respiratory activity.
• I rritability is a reflex response to stimuli.
• T one – muscle tone.
• C olor – color of the skin.

Why doesn’t a healthy baby with an easy birth get an Apgar score of 10?

Each child individually experiences the process of adaptation to independent life outside the mother’s body. Assessing viability using this table is considered objective, but there are also subjective factors:

1. In order for the baby’s circulatory system to fully function on its own, it takes about 5 minutes. Until this time has elapsed, the arms and legs may retain a bluish coloration.
2. There are cases when a healthy baby receives a low Apgar score only because he does not scream, but with interest and carefully examines the new environment in which he finds himself.
3. The professionalism of the doctor also influences the analysis of the situation in the first minutes after childbirth. This is just a kind of test for the physiological criteria of the baby’s viability.

Decoding the Apgar score does not affect the physical development and intellectual usefulness of the child.

In the first year of life, scores at birth of a child of 8/8 or other possible combinations of scores will be of interest to the pediatrician, pediatric neurologist and other highly specialized pediatric doctors.

Read also:

A newborn, where, along with weight and height, the Apgar score is indicated. These are just two numbers, for example 7/8 or 8/9, which do not say anything to parents, but mean a lot both to the baby and to the pediatrician. By what criteria are this first “assessment” made?

What is the Apgar score?

This is a system for quickly assessing the condition of a newborn to determine the need for emergency medical care. The scale was proposed by the American anesthesiologist Virginia Apgar in 1952.

To make it more convenient to remember indicators, Virginia Apgar developed a system where each letter of the APGAR surname determined:

• A (appearance) - skin color;
• P (puls) - pulse;
• G (grimace) - grimaces;
• A (activity) - movement activity, muscle tone;
• R (respiration) - respiratory movements, reflex excitability.

The Apgar scale involves a summary analysis of five criteria: skin color, heart rate, reflex excitability (grimace, cough), muscle tone (motor movements), breathing pattern - each of which is assessed with integers in points from 0 to 2 inclusive. Thus, the overall score can range from 0 to 10.

How are points calculated?

Apgar scores quantify and summarize the newborn baby's response to the ectopic environment and resuscitation (restoration of severely impaired or lost vital functions of the body - measures aimed at restoring heart contractions and breathing). Each of the five signs is assigned a value of 0, or 1, or 2. The five values ​​are then summed and the result is the Apgar score.

Apgar scores should be determined at 1 and 5 minutes after birth. If the sum at 5 minutes is less than 7, additional measurements should be taken every 5 minutes for the next 20 minutes.

What is considered the norm?

In most newborns, the condition 1 minute after birth on the Apgar scale is estimated at 7-8 points, and after 5 minutes the assessment of a healthy baby reaches 8-10 points. Only 15% of newborns have a general condition of 10 points in the first minute of life. Children who score between 7 and 10 are considered to be in good or excellent condition and require only routine care. An Apgar score at birth of 0-3 points (pulse less than 100 beats/min, slowing, absence of breathing or changes in it, pale skin, muscle atony) corresponds to severe asphyxia (lack of oxygen). A score 1 minute after birth of 4-6 points (unsteady breathing, heart rate 100 beats/min or more, decreased muscle tone, weak response to irritation) corresponds to a moderate degree of asphyxia. Such a child may require only some resuscitation procedures. A score of 6 or lower 5 minutes after birth is an indication for intensive care or continued resuscitation.

The positive dynamics of the baby’s condition allows us to hope for a favorable prognosis with a low Apgar score, that is, if by the 5th minute the baby confidently adds 1-2 points to himself. Children with a low score have an increased likelihood that in the future they will need observation, and possibly treatment from a neurologist. However, recent indicators indicate that most of these children grow up normal and quite healthy.

A low Apgar score is usually associated with the fact that the child experiences oxygen deficiency, that is, is in a state of hypoxia, and this can be either a state of chronic hypoxia, which formed during pregnancy, or a state of acute hypoxia - oxygen starvation that arose during pregnancy. childbirth The causes of chronic hypoxia, as a rule, are various pathologies of pregnancy and, possibly, developmental defects, and the causes of acute hypoxia are various complications of childbirth. Premature babies tend to have lower Apgar scores than full-term babies.

A pediatrician evaluates the baby's condition after birth. Usually a professional needs 40-60 seconds for this; for this, he has a lot of basic but informative techniques in his arsenal. There is a clear algorithm that the doctor adheres to after discovering certain results. Breathing, heartbeat and skin color are leading indicators.

Apgar score criteria	0 points	1 point	2 points
Skin coloring	Pale or cyanosis (bluish coloration)	Pink coloration of the body and bluish coloration of the limbs (acrocyanosis)	Pink coloring of the whole body and limbs
Heart rate per minute	Absent		>100
Reflex excitability (baby’s reaction to the insertion of a nasal catheter)	Does not react	The reaction is weakly expressed (grimace, movement)	Reaction in the form of movement, coughing, sneezing, loud screaming
Muscle tone	Missing, limbs hanging	Decreased, some limb flexion	Active movements are expressed
Breath	Absent	Irregular, weak cry	Normal, loud scream

Breathing assessment

• lack of breathing- begin artificial pulmonary ventilation (ALV). To do this, in the maternity ward, they use the so-called “Ambu bag”: a mask is applied to the baby’s nose and mouth, through which air is forced into the lungs using a rubber bag. If necessary, the child is transferred to the intensive care unit, where they are connected to an artificial respiration apparatus;
• independent but inadequate breathing (convulsive or irregular, shallow)- begin artificial ventilation;
• independent regular- assess heart rate.

Heart Rate Estimation

1. Determine heart rate for 6 seconds using one of three methods;
   • listening;
   • palpation of the apical impulse (the doctor palpates the baby’s chest to determine the heartbeat);
   • palpation (feeling) of the pulse in the carotid, femoral or umbilical arteries (by pulsation of the umbilical cord).
2. By multiplying the heart rate (HR) for 6 seconds by 10, you get the heart rate per minute.
3. Possible assessment options and further actions;
   • Heart rate is less than 100 beats per minute - mask artificial ventilation of the lungs with 100% oxygen is performed until normal heart rate is restored.
   • Heart rate is more than 100 beats per minute - assess the color of the skin.

Skin color assessment

Possible assessment options and further actions:

1. completely pink or pink with cyanosis (blue tint) of the hands and feet - monitor the baby’s condition. If everything is normal, the baby is put to the breast;
2. bluish skin and visible mucous membranes - inhale 100% oxygen through a face mask until the bluishness disappears,

Sometimes low scores obtained by a baby on the Apgar scale cause unjustified concern for the child’s future. Please do not forget that the Apgar scale is not an assessment of the development and condition of the child as a whole, and, moreover, not an assessment of his intellectual potential. Its main purpose is only to determine the baby’s condition immediately and determine the need for emergency medical care.

Alexander Gerasimov
Neonatologist,
head of children's department
intensive care unit of maternity hospital No. 15,
Moscow

The Apgar score after 1 minute indicates the initial condition of the newborn and indicates those children who require more attention, and the score at 5 minutes indicates effectiveness. Therefore, there are always two Apgar scores, for example 8/8 points. In most newborns, the condition 1 minute after birth on the Apgar scale is estimated at 7-8 points; after 5 minutes, the general condition of these newborns corresponds to 8-10 points, which is prognostically favorable. If a mother finds out that her baby has been diagnosed 8 points, then gets very upset.

The first test that newborns undergo (and most do well) is the Apgar score. The test was proposed in 1952 by American anesthesiologist Virginia Apgar. The result, recorded one minute after birth and recorded again 5 minutes later, reflects the overall condition of the newborn and is based on observations in five assessment categories. Children who score between 7 and 10 are considered good or excellent and usually require only routine care; those who score between 4 and 6 points are in fair condition and may only require some resuscitation procedures; and those whose score is less than 4 require immediate assistance to save their life. At one time it was believed that children whose score remained low 5 minutes after birth were doomed to have neurological problems in the future, but recent studies have shown that most of these children grow up normal and quite healthy.

Apgar score.

To identify hypoxia and determine its degree, newborn children are usually assessed using the Apgar scale (see table below). The assessment is carried out at 1-5 minutes of life using 5 clinical signs, each of which is scored from 0 to 2 points. The maximum amount is 10, the minimum is 0. A score from 1 to 4 points indicates severe hypoxia, and 5-6 indicates mild hypoxia. A score from 7 to 10 indicates a satisfactory condition.

It should be emphasized that the Apgar score unilaterally characterizes the condition of newborns. It states the presence or absence of hypoxia at the time of birth. If low scores on the Apgar scale guide the doctor towards antihypoxic therapy, including resuscitation, then a score of 7-9 points does not guarantee complete well-being. A few hours after birth, the condition may deteriorate due to respiratory distress syndrome or other pathology.

Apgar score table

Assessment of the condition of a newborn baby in the first minute of life

Signs	0 points	1 point	2 points
Pulse	Absent	Less than 100 beats/min	More than 100 beats/min
Breath	Absent	Slow, irregular	Good, shout
Muscle tone	Weak	Bends arms and legs	Actively moving
Reflexes (reaction to a catheter in the nose)	Absent	Grimaces	Sneezes, coughs, pushes away
Color of the skin	Blue, pale	Normal, but bluish arms and legs	Normal throughout the body

Evaluation of Apgar test results

This testing is usually carried out within one to five minutes after the baby is born, and can be repeated later if the results are poor.

Scores less than 3 indicate a critical condition of the newborn, more than 7 is considered a good condition (normal).

The Apgar score was developed for health care providers to determine which children require closer monitoring.

The child who received 5 points, needs closer monitoring than a child who has received 7-10 points.

A child who received a scale 5-6 points a minute after birth, but five minutes later it increased to 7-10 , moves into the category of children about whom you don’t have to worry.

A child who started life with an Apgar score of 5 and remained at the same 5 points 5 minutes after birth ( 5-5 points), needs more careful monitoring. A perfect 10 score is rare.

All indicators are monitored in the first minute after birth, then at the fifth minute of life.

In some cases, especially with low values, the Apgar score is given at the 10th minute of life. Babies after cesarean section tend to score higher on the Apgar score because they do not experience difficulty moving through the birth canal.

Mother and relatives are usually told two numbers, for example, 8-9 or 9-9 Apgar scores indicate that the baby’s condition immediately after birth is good.

Here are examples of interpreting Apgar scores

3-3 points- critical condition of the child

5-6 points and below - below average - requires careful monitoring.

6-7, 7-8 scores average - does not require careful observation

8-8 points above average.

8-9, 9-9, 9-10 points - good

10-10 points- perfect (doesn't happen!)

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The Apgar scale is used by neonatologists (these are doctors who specialize in newborn babies) and resuscitators to quickly assess the condition of a newly born baby. The data from this assessment must be included in medical documents. This assessment is also reported to parents along with height and weight measurements.

Let's imagine a real situation in a maternity hospital. A mother who has just been transferred from the delivery room to a ward is told: your baby weighs 3200 g, height is 53 cm, and the Apgar score is so many points.

Mommy has not yet fully recovered from the stress of childbirth. What will she mostly understand from this message? Yes, she will understand the information about height and weight. What are these Apgar scores? Is it good or bad? In 90% of cases, this is incomprehensible information for the mother.

Yes, as a rule, these numbers mean absolutely nothing to parents, since they are used in a narrow circle of doctors. Many parents do not understand why their child was given this or that score. Many people ask questions: how important is this indicator, what can it affect in the future?

Today I will try to clearly explain this purely medical technique to interested parents.

A little history

Let's start with a little historical background.

More than half a century ago (1952), anesthesiologist Virginia Apgar from America developed a method for assessing the condition of babies in the first minutes of life.

Since then, resuscitators, neonatologists and pediatricians have used this technique to assess the condition of an infant to determine the need for resuscitation procedures immediately after birth.

Later, in pediatric practice, an easy-to-remember alternative interpretation of the name of the scale was introduced, consonant with the name of the creator. That is, they simply began to call this technique an assessment on the Apgar scale, where each letter of the surname indicates a certain indicator of the baby’s condition.

In assessing the condition of the baby using this method, the following indicators are assessed:

A ppearance - appearance (skin color);

P ulse (Heart Rate) - baby’s pulse (heart rate);

G rimace (Response to Stimulation) - a grimace that occurs in response to irritation;

A ctivity (Muscle Tone) - motor activity, muscle tone;

R espiration - breathing movements.

What is the Apgar score used for?

The Apgar score helps health care providers determine which children require closer monitoring.

The scale is designed to determine the main indicators characterizing the condition of the baby at the 1st and 5th minutes of life.

Sometimes, more often in the case of low primary indicators, specialists continue assessing the scale up to 20 minutes, with an interval of five minutes. Such observation over time also allows us to give an adequate assessment of the medical care provided to the baby.

The assessment of the baby on the Apgar scale should be carried out promptly by specialists. After all, delay at such a moment is unacceptable.

Assessment algorithm

The baby’s condition is assessed using five indicators: pulse, breathing, muscle tone, baby’s skin color and motor activity (reflexes).

Each criterion is scored from 0 to 2 inclusive. In this case, 0 points indicates the absence of a sign, 1 - weak expression, 2 - strong expression. The scores are summed up. The final total score can range from 0 to 10 points.

The Apgar scale is clearly presented in the following table

Feature being assessed	0 points	1 point	2 points
Appearance (Skin Color)	Almost all skin is pale or bluish in color	The skin of the body is pink, the limbs are bluish	The entire surface of the body is pink in color
Baby's pulse	Absent	Less than 100 beats per minute	More than 100 beats per minute
Reflexes	None. No reaction to irritation	Mild reaction in the form of a grimace, movement	Pronounced reaction in the form of animated movement, sneezing, loud screaming
Muscle tone	Absent, baby's limbs hanging down	The tone is reduced, the limbs are slightly bent	Flexion tone is observed, motor activity is pronounced
Breath	Absent	Intermittent shallow breathing, weak cry	Normal breathing, loud scream

Learn more about the evaluation criteria

Newborn skin color (Appearance) is a simple and accessible criterion. At the same time, this indicator is very informative. It allows you to quickly diagnose circulatory disorders.

If we compare this criterion with others, then on this basis children receive the full 2 ​​points less often than on other criteria on the scale.

In principle, this is normal. After all, most children born through natural childbirth have red skin and bluish limbs. In a natural birth, a child spends a lot of strength and energy when passing through the birth canal, and, whatever one may say, in any case experiences moderate oxygen starvation. Hence the changes in skin color.

But “Caesarean children”, born by caesarean section, more often receive two points on this indicator. They were born with less effort and less energy.

Heart rate (Pulse). After birth, a baby’s heart beats very quickly compared to adults. After all, the little one had to work hard.

Normally, the heart rate (HR) of a newly born toddler is 120-140 beats per minute. According to the Apgar scale, a baby's heartbeat faster than 100 beats per minute is assessed with a maximum score of 2 points.

If the child experienced oxygen starvation (hypoxia) in the womb, then after birth such babies experience a slowdown in respiratory and cardiac activity. Then the heart rate is below 100 heart beats per minute.

If there is no cardiac activity immediately after the baby is born, Pulse points are not added.

Reflexes and reactions to stimuli (Grimace). Normally, newly born babies have unconditioned reflexes. Therefore, after birth, babies move actively, take their first breath, and scream loudly.

After birth, the baby is surrounded by many stimuli (light, sound, temperature changes).

Plus, kids also need to endure such an unpleasant medical procedure as suctioning mucus from the nose. The reaction to its implementation can manifest itself to varying degrees.

Lack of response to stimuli is an unsatisfactory indicator and is scored 0 points. A weak reaction in the form of a grimace and inactive movement - 1 point. A reaction in the form of active movement, loud screaming, sneezing, coughing is assessed as 2 points.

Muscle tone (Activity). Normally, a newborn has increased muscle tone. This is to some extent an echo of the forced position in the womb (fetal position).

After birth, the baby’s limbs are normally bent and brought to the body. Active, chaotic, sharp movements of the limbs indicate satisfactory muscle tone.

This condition confirms the good adaptive capabilities of the newborn’s body. Therefore, such children deserve a maximum score of 2 points.

Breathing (Respiration). For a newborn, respiratory activity with a respiratory rate of 40-45 per minute is considered satisfactory and is scored 1 point.

If the baby, having just been born, also screamed loudly, then he will have a maximum Respiration score of 2 points. A loud cry helps the little one breathe more intensely and is considered a sign of the baby’s good adaptive capabilities.

If the baby does not scream immediately after birth, but cries almost silently (“the voice trembles”), and shallow breathing is noted, then his state of the respiratory system will be assessed at 1 point.

In the absence of breathing (asphyxia), points for the Respiration indicator are not calculated.

How to interpret the total score? (from 0 to 10)

10 points is the best indicator. Domestic doctors rarely diagnose it. Abroad, in medical practice, the maximum score can often be found. But our specialists practically do not install it.

And here the reasons for this state of affairs are different for each doctor and in relation to each specific child. You need to understand that the methodology is initially based on a subjective assessment of indicators.

Of course, the peculiarities of the organization of the healthcare system and the peculiarities of the mentality of our people are important here.

Somehow it is not customary for us to declare complete well-being. Especially if the situation may change unexpectedly for any reason. And even more so if we are talking about the fragile body of a baby who has just been born. Therefore, there are probably situations in the category of “playing it safe” or “not to jinx it.”

7-8-9 points is the optimal assessment of the baby’s condition, indicating his good health. Such scores indicate that the period of early adaptation is going well. After birth, the child does not need particularly close supervision by medical staff. All he needs is good care.

5-6 points – the baby’s condition is satisfactory. There are slight deviations from the norm. More careful monitoring by medical staff is required in the postpartum period.

3-4 points – assessment of the condition below average. The child needs medical attention. This indicator requires continued examination according to Apgar criteria at the tenth-fifteenth-twentieth minute of life. Such an assessment will show the results of the resuscitation measures carried out over time.

If the baby was born with an Apgar score of 3-4, he is closely monitored in the first weeks after birth.

0-1-2 points – critical indicators. The baby needs urgent resuscitation care. In the future, such a child must be comprehensively examined and carefully monitored by specialists in dynamics.

I will also clarify in what form the examination results are presented in medical documents.

Since the assessment is carried out twice (in the first and fifth minutes), the result is written in two numbers separated by a slash. For example, 8/9 points.

In most cases, the second estimate is higher than the first. This indicates positive dynamics in the baby’s condition. That is, the child’s adaptive resource is good and is successfully implemented after childbirth.

As a rule, during the second examination, five minutes after birth, the baby’s heart rate increases, breathing normalizes, and the skin acquires a normal pink color. Children become more active. Protective reflexes and reactions to stimuli improve.

If the second score is lowered (9/8 or 8/7), medical monitoring of the newborn is intensified. This means that after birth the baby has difficulty adapting to new conditions.

Maximum rating: parents are happy, doctors are calm

Parents often ask: in what cases is a newborn given a maximum score of 10 points? This has already been discussed in this article above. I repeat once again that our doctors rarely give the maximum score to children.

More often, this score is determined by the subjective opinion of the doctor. But in fairness, it must be said that objective reality often does not contradict subjective assessments. It is rare that a baby, after a labor-intensive process of birth and extreme stress in connection with this, can show high results.

The most common Apgar score for healthy children is 8 points. This means that the baby has a normal score and is given the maximum score for three criteria, although there is a slight decrease (1 point) for two out of five parameters. For example, due to the cyanosis of the limbs and the state of muscle tone.

Every parent is pleased to hear that their child received the maximum grade. But here it is important to understand that the Apgar scale only assesses the viability of the baby and its adaptive capabilities immediately after birth. This scale score is in no way equivalent to any diagnosis.

Therefore, you should not worry at all about a score of 7-8 points. This is an absolutely normal assessment for a newborn.

What depends on mom?

There is no direct relationship between the mother's health status and the baby's Apgar score. But, at the same time, maternal smoking, alcohol consumption during pregnancy, poor nutrition, and untreated chronic foci of infection in a pregnant woman can lead to oxygen starvation and intrauterine infection of the fetus.

This will undoubtedly affect the child’s condition, his respiratory and motor functions after birth. As a result, this will significantly reduce your Apgar score.

At the time of childbirth, a lot also depends on the mother. The color of the baby’s skin immediately after birth will depend on how she pushes and whether she listens and follows the doctors’ instructions during childbirth.

Also, if labor is prolonged due to weak labor, the baby will experience a lack of oxygen for much longer than during the normal duration of labor. And at birth, the activity of the respiratory and cardiovascular systems will be unstable in a rather exhausted baby. Therefore, the baby’s Apgar score will be 1-2 points lower than it would have been during a normal birth.

What can the assessment result influence in the future?

So, if after birth the baby’s Apgar score is greater than or equal to 7-8 points, then the little one is in good condition. Therefore, he can stay with his mother until discharge.

If the baby receives an overall score below 7 points, he will be taken away from his mother for medical care and dynamic observation until his condition stabilizes.

I would like to say that the assessment results do not reflect the full picture of the baby’s health. The purpose of this method is to determine the viability of the baby in a matter of seconds.

This assessment is only relevant at the time of birth. The assessment system helps doctors respond in a timely manner and provide the necessary care to the newborn. It does not make it possible to judge directly the state of health or mental abilities of the baby in the future.

In some situations, specialists in the first year of a baby’s life may pay attention to the amount of Apgar scores. This is sometimes necessary to clarify the picture of the baby’s development from birth.

But over time, these numbers will remain just history, like all other information recorded in the newborn’s discharge.

High Apgar scores are nothing to be proud of. And low numbers are not a reason for additional alarm. That’s why, in order not to worry about not knowing what and why with this rating scale, it’s worth learning about it during pregnancy.

In this article:

For more than 60 years, our newborn babies have undergone their first exam - assessing their condition using the Apgar scale. What is it and what is it needed for?

62 years ago in 1952, the first American woman professor, MPH, director of the National Foundation for Birth Defects, Virginia Apgar, proposed a system for determining the condition of newborns in the first minute of life using a 10-point system - the “Apgar Newborn Score.” To make it easier to remember the evaluation criteria, I used the initial letters of my last name:

1. A- the child’s appearance (skin color);
2. P - child's pulse (HR);
3. G- grimace (reaction in response to a stimulus);
4. A - activity and muscle tone of the baby;
5. R - breathing movements of the child.

Each criterion is assessed by a number of points from 0 to 2. The sum of points determines the child’s condition at a certain moment and ranges from 0 to 10.

The Apgar score contains complete information about the child and is intended primarily for the maternity hospital doctor to be able to quickly respond and determine which of the babies needs emergency assistance in emergency medical procedures, or just more careful attention.

Scoring method

The number of points gives an assessment and generalizes the baby’s reaction in the first minute of life (in the ectopic environment) - restoration of violations of important body functions, measures aimed at restoring a possible failure of heartbeats, and breathing problems during childbirth. Each of the five criteria is assigned a score - 0, 1 or 2 points. The best total score is 8, 9, and 10 points.

The rating on this scale is determined in the first and fifth minutes after birth. Therefore, there are always two of them - for example, 7/8 or 8/9 points. Usually by the fifth minute the baby can add up to 2 points. If the sum of points in the fifth minute of the child’s life does not exceed -7, a control examination is carried out within 20 minutes, every 5 minutes.

• An Apgar score of 7, 8, 9 and 10 points characterizes the condition of the newborn without visible pathologies. Very few children receive the maximum score of 10, mostly 7/8 and 8/9 points. The second score, given by the fifth minute, is usually 1 or 2 points higher, although not always. It can remain, for example, 8/8 or 9/9. Such babies are immediately placed on their mother’s breast and placed under her care.
• The condition of newborns assessed at 6 points is evidence of unsteady breathing, decreased muscle tone, poor response to stimuli with a pulse rate of 100 beats/min or more. This condition is evidence of a moderate degree of asphyxia (lack of oxygen). The condition assessed with a 6-point rating is considered satisfactory, but requires certain therapeutic measures.
• Urgent resuscitation care is measures to prevent the development of complications or save lives, the condition of which is required for babies, rated from 4 to 6 points.
• The result according to this system in the first minute of birth is from 0 to 3 points, evidence of a slow pulse, changes or absence of breathing, pale skin, and muscle atony. This condition is the result of severe asphyxia.

A low Apgar score - from 3 to 6 is due to the fact that the child has an acute lack of oxygen, and this is evidence of the presence of chronic hypoxia, which formed during pregnancy, or oxygen starvation that occurred during childbirth.

The cause of chronic hypoxia may be:

• Pathology of pregnancy;
• Possible fetal malformations.

The cause of acute hypoxia is varying degrees of complications during childbirth.

Not always a low criterion score can lead to disastrous results. Positive dynamics in the baby’s condition, according to the Apgar scale, allows us to hope for a positive result. If within five minutes the baby adds 1 or 2 points to himself, which will raise the indicator to at least 6, he has a chance to get out. For the most part, such children are quite normal and healthy, only some may need treatment or observation by a neurologist.

Premature children have a criterion score lower than full-term children and it rarely exceeds 6 points. But don’t be upset by the lack of 9 or 10 points, because this is a purely preliminary test, and is mainly intended for medical analysis. And the further development of the child depends only on the attention and care of the parents.

Causes of adverse events

Severe conditions of newborns are caused not only by the presence of asphyxia during childbirth or immediately after it. They can be the result of many other factors - injuries or infections.

• A mild form of brain damage - “neuro-reflex excitability syndrome”, estimated at 7 points on the Apgar scale
• Moderate severity - “central nervous system depression syndrome” and “hypertensive-hydrocephalic syndrome” are rated from 6 to 7. The cause may be unfavorable factors during pregnancy and childbirth.
• Severe lesions of the central nervous system cause comatose and convulsive syndromes, and certification on this scale = 1/4 unit. Such children are transferred from the maternity hospital to a hospital and only with a persistent improvement in their condition with a score of 7, they are discharged home under the supervision of a pediatrician and neurologist.

Most children with scores of 6/7 points who have suffered mild, moderate or even severe forms of perinatal encephalopathy, with proper care, completely restore the activity of the central nervous system. So, a low initial Apgar score is not a reason to panic.

Evaluation of criteria - from heart to skin color

Work of the heart

A baby's heart works harder than an adult's. Heart rate, ideally – 130/min, 140/min. This type of heart work is estimated at 2 points. Slow heartbeat – 1, in the absence of heartbeat or isolated manifestations = 0.

The heart rate (HR) is determined within six seconds in the first minute of the child's life. Method:

• listening;
• palpation - palpation of the chest to determine the heartbeat;
• palpation of the pulse in the femoral, carotid or umbilical arteries.

The result of heart contractions determined in six seconds is multiplied by the number - 10, and the number of contractions per minute is determined.

• Children whose heart rate per minute is less than 100 beats are given artificial ventilation with oxygen until their heart rate normalizes.
• If the result is a heart rate exceeding 100/sec. – the condition of the skin is assessed.

Respiration rate

With normal breathing, the child makes 40 to 45 breathing-exhalation movements per minute. The cry is shrill and loud, in this case the baby earns +2 points. With slow and irregular breathing, a low cry or a moan instead, the child earns one. In the absence of both, certification = 0.

• If the child is not breathing, in the maternity operating room, in order not to lose precious time, he is ventilated using an Ambu bag - a mask is applied to the mouth and nose, and air is manually pumped into the baby’s lungs using a rubber bag. After providing first aid and stabilizing the child’s breathing, he is transferred to the rehabilitation unit.
• In case of convulsive, shallow, or irregular breathing, a ventilation procedure is performed. In such non-standard situations, we are not talking about high -9/10 indicators.
• If breathing is spontaneous and regular, heart rate and Apgar readings are assessed. These could be 7/8 or 8/9.

Muscle tone assessment

If everything is normal with the newborn, having just been born, he strives to get rid of the “embryo” position and, feeling free, actively waves his arms - he gets 2 coveted points.

It is possible that they will increase his performance to a rating of 9/9 or even 9/10. With bent arms and legs, weak and rare movements - 1 point, which on the scale is rated as 4/6 or 6/7, taking into account the heartbeat and breathing rate. No movement = 0 points.

Reflex assessment

Despite its helplessness, thanks to its innate reflexes, a newly born baby can already do a lot. Clearly expressed swallowing, sucking and grasping reflexes will add 2 more points to his piggy bank. This will bring him closer to the coveted 10 points. The absence of some reflexes or their insufficient expression is limited to a score of +1, and the complete absence of reflexes = 0.

Skin color

Ideally, pale pink or hot pink color of the newborn + 2 points. Thus, the total of 2 points of all five indicators leads to the ideal option = 10 points.

The presence of a bluish tint on the arms and legs is an indicator of hypoxia. Rating +1. Excessively pale skin with a bluish tint = 0.

The overall score earned by the newborn is included in the child’s record upon discharge from the maternity hospital. It is an indicator for the local pediatrician to immediately pay attention to possible problems in the baby’s health. Based on these results, vaccination schedules are drawn up and more intensive medical care is provided.

Don't be upset about low scores. The assessment of a newborn on the Apgar scale with standards of 10 points is not an indicator of its development and an assessment of intellectual potential. Care, love and attention will allow the child to receive excellent grades in the future, regardless of those he received in the maternity hospital.