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You are here: Home - Pregnancy - Labor & Childbirth

The Apgar Test: Baby's First Test

by Katlyn Joy | January 12, 2012 11:24 AM
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Are you ready for your baby's first test? This screening test is administered to newborns at least twice, at one minute and five minutes after birth.

The Apgar test was developed by Virginia Apgar who was an anesthesiologist and doctor. The letters in the name Apgar correspond to sections of the scoring for the exam. "A" is for activity level; "P" is for pulse; "G" is for grimace; the second "A" is for appearance; and "R" is for respiration.

Activity

Activity, also referred to as muscle tone looks specifically at the newborn's movements and muscle level. For active movement, 2 points are awarded. Babies that bend or flex their limbs are given 1 point. Those who are limp receive 0 in this category.

Pulse

The pulse or heart rate looks at just how strong the heart beat sounds. For those with a pulse above 100 beats per minute, 2 points are calculated while under 100 receives 1 point. Those without a pulse receive 0.

Grimace

Grimace refers to reflex irritability. Babies who react with sneezes, pulling away or crying are given 2 points, while those who only grimace or react facially, such as with a grimace are given 1 point. No response results in 0 points.

Appearance

Not a beauty contest category, this actually assesses an infant's color. Newborns who are normal color, with pink feet and hands get 2 points, and those with normal color with only bluish tone to the feet and hands are awarded 1 point. Infants who are bluish-gray all over receive 0 points.

Respiration

Respiration or breathing in the newborn is calculated as good and crying awarded 2 points, slow or irregular breathing gets 1 point while absent respiration receives a 0.

What it Means

Babies who score overall in the 7 to 10 range are expected to require only normal post-delivery care. Newborns that get Apgars between 4 and 6 may need some assistance particularly with breathing. Babies getting a score below 4 will likely require resuscitation.
If scores are 7 are below, the test may be repeated at 10 minutes. The neonatal resuscitation program or NRP guidelines state that the Apgar should be repeated every 5 minutes for 20 minutes for any score of less than 7 at the original 5 minute mark.

This score doesn't indicate a serious birth complication or definitely diagnose any condition in newborns. It's an evaluation that is done on a somewhat subjective basis so it is not a precise test as such. It's more of a screening tool to help physicians to assess a newborn's initial condition.

Few babies receive a score of ten. It's even a bit of a joke that only doctor's newborns receive such high marks.

What it Doesn't Mean

You cannot look to an Apgar score to predict a newborn's future medical or developmental functioning. The score is affected by gestational age, medications given to the mother during labor, and breathing conditions or heart conditions. Scores can vary depending on who gives them. Some believe those assisting the birth should not conduct the Apgar as they may have a vested interest in the score.

Specifically, babies who are premature or went through a difficult labor and deliver, including those born via cesarean are likely to receive lower Apgar scores even though in good health. Some babies just require a bit more time to adjust to life outside Mom.

Parents should be aware of the implications of the Apgar test and not become overly concerned with the score. Most children who received lower scores on the Apgar just need a bit more attention at birth and go on to develop into healthy babies who develop on target.

Newborns who receive very low scores on repeated Apgars likely need extra help breathing and their future prognosis is solely dependent on the reasons why the low scores were awarded. If your baby arrived many weeks early, the challenges that may lie ahead are due to prematurity not the lower Apgar scores.

The Future of the Apgar

It is recommended that physicians and health care professionals attending infant births be routinely trained in doing Apgar assessments to ensure a more reliable and consistent scoring outcome. Parents should also be educated on exactly what the Apgar is and isn't to avoid unnecessary anxiety in new parents.


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