Newborn: physical indicators, care. Assessment of the condition of the newborn

From the moment of birth and up to 28 days of life, neonatologists should deal with newborns. These are the narrow specialists of the pediatric service. Childbirth is stressful for both the woman and the baby. His body enters a new environment and must quickly adapt to it. But during pregnancy or childbirth, it may suffer, which will worsen the adaptation period. The Apgar score is used to determine how much help a newborn needs. This is a scoring system that allows you to quickly assess his condition.

Why is such an assessment necessary?

American anesthesiologist Virginia Apgar proposed a system that would allow subjective assessment of the condition of the newborn and the need for resuscitation. In 1952, this system was introduced to the scientific community.

The speed of first aid determines the further position of the newborn. In some cases, it is known in advance that the child was in chronic hypoxia and received less nutrition. Childbirth will affect his health, the help of resuscitators may be required. May lead to serious condition the following complications pregnancy:

• alcohol abuse, smoking;
• at mother;
• intrauterine infections;
• diseases of the cardiovascular system;
• fetal malformations.

Sometimes hypoxia develops in one or both fetuses when multiple pregnancy, breech presentation. For women who are expected to have a serious condition of the fetus, a neonatologist-resuscitator is called in advance to the delivery room, who will be able to carry out high-quality resuscitation measures.

In some cases, during childbirth, acute hypoxia develops, then the help of resuscitators is needed on an emergency basis. The causes of acute hypoxia in childbirth may be the following conditions:

• umbilical cord pathology: entanglement, knots, short umbilical cord;
• premature detachment of the placenta;
• elevated arterial pressure in childbirth;
• uterine rupture.

It can develop during prolonged labor, with a discrepancy between the size of the pelvis and the fetus, when the umbilical cord is clamped in the birth canal.

Assessment of the state of the newborn on the Apgar scale is necessary when premature birth. Premature babies require increased attention, their organs are still immature and cannot fully function.

Main indicators of the system

For ease of remembering, in 1962, pediatrician Josef Butterfield suggested using the initial letters of the surname of the author of the rating system:

• A - appearance - skin color;
• P - puls - the number of heartbeats;
• G - grimace - change in facial expression in response to irritation;
• A - activity - muscle tone;
• R - respiration - breathing.

For each indicator, points are given from 0 to 2. Their sum reflects the level of hypoxia after birth. At birth, the Apgar score is used twice: at the first and 5 minutes after birth. At the same time, the dynamics in points is very important.

Sometimes a child with a low score in 5 minutes manages to recover and add 2-3 points, which puts him in the category with a normal state. But initially low rates alarm pediatricians and require additional attention from them.

If initially low scores (less than 7) do not improve to normal levels by the fifth minute, then such a newborn requires observation and evaluation every 5 minutes. 20 minutes of observations are allotted for the full evaluation.

heartbeat

The number of heartbeats is an indicator that was monitored during pregnancy using. The normal heart rate for a newborn is 120-140 beats per minute. During childbirth, when recording CTG, it is noticeable that during a contraction, the heartbeat slows down, but then gradually recovers. In some children, it may remain in a state of bradycardia, which is an unfavorable sign.

The number of heartbeats is the main sign that can affect the severity of the other components of the Apgar scale. With a normal heart rate, 2 points are set, if its slowdown is noted, then 1 point. In the absence of heartbeats - 0.

Slowing down or not listening to heart beats can affect skin color, breathing, and muscle tone. Therefore, the score on the scale will be very low.

Breath

The first evidence of normal breathing is a cry. At the same time, the lungs expand, the arterial ducts close, which supply the organs with blood bypassing the lungs. Loud and shrill cry immediately after birth gives 2 points on the scale. One point is given for a weak cry, its slow appearance, the appearance of a groan instead of a scream. Zero - with the complete absence of sounds.

Muscle tone

During fetal development, the fetus is in the fetal position with legs bent and brought to the chest and arms crossed. His muscles are in a state of hypertonicity. After birth, he actively involuntarily begins to wave his arms. If the movements are pronounced, 2 points are set, with slight swings, reduced tone of the limbs - 1. The complete absence of movements, together with an assessment of breathing and heartbeat, can give 0 points.

It is easy to evaluate this indicator in the first minute according to the behavior of the newborn. Pediatricians also use the methods of flexion-extension of the arms in the elbow joints, in the shoulders, various leg movements to check the tone.

reflexes

Nervous excitability is assessed when a catheter is inserted into the nose. This is an unpleasant procedure that is necessary to remove mucus from the nasal cavity and mouth to make breathing easier. If the child expressively grimaces in response to the stimulus, 2 points are set. Poor reaction to the introduction of a catheter into the nose - 1. No reaction - 0 points.

At birth, children are registered unconditioned reflexes, which are laid down by nature and are necessary for survival. The severity of the reflexes indicates the readiness of the fetus for birth and its good condition. The ability to swallow, the grasping reflex, the proboscis reflex (stretching the lips when touching them), sucking and some others (reflex walking and crawling, bringing and spreading the arms, reaction to foot irritation) are evaluated. Such reactions to stimuli are temporary. At an older age, they should gradually fade away and be replaced by conditioned reflexes. Preservation of reactions, like a newborn, to stimuli more due date transfers reflexes to the pathological group.

Skin color

The condition of the skin depends on the severity of hypoxia. Apgar score criteria are as follows:

• 2 points - pale pink or pink skin;
• 1 point - pink body, limbs with signs of cyanosis (cyanosis);
• 0 points - pallor or cyanosis of the body and extremities.

The color of the skin is not the main indicator. It is in direct connection with the breathing and heartbeat of the baby. The deterioration of these indicators leads to changes in the skin.

Table for assessing the condition of the newborn on the Apgar scale:

Evaluation of results

An experienced pediatrician needs 30-60 seconds to evaluate a child. Immediately after birth or removal from the uterus during surgery, you can see the color of the skin. Few of the children are perfect pink skin. In most cases, there is a slight cyanosis of the face and extremities. But after 5 minutes in the absence pathological changes in other organs, the skin becomes pink.

The obtained measurement results are calculated. The score includes two digits - points for the first and fifth minutes. The decryption looks like this:

• 10-7 - the optimal result;
• 5-6 - slight deviations;
• 3-4 - deviations from the norm medium degree gravity;
• 2-0 - severe violations.

A newborn's Apgar scores do not indicate the state of his development. nervous system, mental capacity. This is a technique that reflects the state of the cardiovascular and respiratory systems. Its value for further development is minimal. Only in the case of prematurity, low scores at birth can indirectly indicate deviations in health.

Help for children with low scores

An abnormal Apgar score forces the doctor to act quickly.

The first indicator that is assessed is breathing. If it is absent, then resort to artificial ventilation of the lungs. In the conditions of the delivery room, an Ambu bag is used. This is a special device that resembles a rubber bulb with a mask on one end of the tube. Gradually squeezing and relaxing it, the doctor pumps air into the lungs. If with the help of the bag it was not possible to “breathe” the newborn, then he is urgently transferred to the intensive care unit, where a ventilator is connected.

With spontaneous breathing, but its changed character (weak, convulsive), they also begin with lung ventilation. Good respiratory performance allows you to proceed to the assessment of cardiac activity.

The heart rate is determined in 6 seconds in different ways:

• listening with a stethoscope;
• palpation determining the place of the apex beat of the heart;
• probing the pulse on the carotid, femoral or umbilical arteries.

The data obtained in 6 seconds is multiplied by 10. This is how the true number of heartbeats is obtained. Then they act depending on the frequency of strokes:

1. Less than 100 - mask inhalation of 100% oxygen is required. It is carried out until the moment of complete restoration of heart contractions.
2. If the heart rate is more than 100 beats per minute, then you can proceed to the next step - to assess the color of the skin.

A child whose skin color is normal can be immediately applied to the breast. If blue extremities are observed, inhalation of oxygen is necessary. With severe cyanosis, it is also recommended to "breathe" the child. If cyanosis is mild, the newborn is observed and, if necessary, assisted.

Consequences of low performance

The doctor's concern is not the decoding of the Apgar scale with low scores, but the condition that led to hypoxia.

Premature babies are the hardest. These include babies born before 37 weeks. The functional immaturity of organ systems affects their general condition. It also matters the weight with which it was a child is born. Low weight is considered to be a weight of 2500 g, regardless of the gestational age. 1500 g or less is considered very low, and less than 1000 g is considered extremely low.

Children in critical condition for a long time are in the intensive care unit. Many manipulations in order to save the life of a newborn affect his future health. For example, the eyes of premature babies are very sensitive to oxygen and light. To avoid damage to the retina, they are sealed. But it is not always possible to completely eliminate the harmful effects. Often in these children, visual impairment progresses with age.

The consequences of an Apgar score of 4 or less are prolonged brain hypoxia. In the future, this can manifest itself as neurological disorders that are difficult to treat.

For premature babies, additional methods for assessing the condition, including the degree of maturity, are also used. Sometimes a child born a little ahead of time, may be mature, and an infant who was born at the estimated time may have signs of an immature fetus. You should not focus too much on these indicators.

To objectively characterize the state of the newborn, the Apgar scale is used. Within the first minute after birth, the 5 most important clinical signs: heart rate and rhythm, breathing pattern and muscle tone, the state of reflexes and the color of the skin. Depending on the severity of these signs, a score is given for each of them:

Heartbeat:

0 points - absent;

1 point - frequency less than 100/min;

2 points - frequency more than 100/min.

0 points - absent;

1 point - weak cry (hypoventilation);

2 points - loud scream.

Muscle tone:

0 points - lethargic;

1 point - some degree of flexion;

2 points - active movements.

Reflex excitability (assessed by the reaction to the nasal catheter or the strength of the reflex to irritation of the soles):

0 points - absent;

1 point - weakly expressed (grimace);

2 points - well expressed (shout).

Skin coloration:

0 points - cyanotic or pale;

1 point - pink color of the body and bluish color of the limbs;

2 points - pink.

The points obtained are summarized and evaluated as follows:

10 - 8 points - a satisfactory condition of the child;

7 - 6 points - mild degree of asphyxia;

5 - 4 points - asphyxia of moderate severity;

3 - 1 points - severe asphyxia;

0 points - clinical death.

To determine the prognosis, the child's condition is re-evaluated on the Apgar scale 5 minutes after birth. If the score has increased (with a lower primary), then the prognosis is more favorable.

For the purpose of early diagnosis of respiratory disorders in premature babies, an assessment is made on the Silverman scale (at birth, after 2, 6, 12 and 24 hours of life); At the same time, the following signs are evaluated in points:

Chest movements:

0 points - the chest and abdomen are evenly involved in the act of breathing;

1 point - arrhythmic, uneven breathing;

2 points - paradoxical breathing.

Intercostal retraction:

0 points - absent;

1 point - unsharply expressed;

2 points - pronounced.

Retraction of the sternum:

0 points - absent;

1 point - unsharply expressed;

2 points - sharply expressed, kept constantly.

Position of the lower jaw:

0 points - the mouth is closed, the lower jaw does not sink;

1 point - the mouth is closed, the lower jaw sinks;

2 points - the mouth is open, the lower jaw sinks.

0 points - calm, even;

1 point - difficult breathing is heard during auscultation;

2 points - groaning breath, heard at a distance.

16. Fetal hypoxia, methods of diagnosis, treatment.

Fetal hypoxia is a complex of changes in his body under the influence of insufficient oxygen supply to the tissues and organs of the fetus or inadequate utilization of oxygen by them.

oxygen starvation in different periods pregnancy has different consequences for the embryo and fetus:

In the pre-implantation period, hypoxia rarely leads to impaired development of a fertilized egg;

During the period of organogenesis, severe hypoxia may be accompanied by a slowdown in the development of the embryo and the appearance of developmental anomalies;

Oxygen starvation during phytogenesis usually leads to malnutrition and hypoxia.

According to etiopathogenesis, the following forms of fetal hypoxia are distinguished:

1. Arterial-hypoxic form:

A) hypoxic - a consequence of impaired oxygen delivery to the uteroplacental circulation:

Respiratory and cardiovascular failure of the mother;

Violation of the oxygen transport function of maternal hemoglobin (anemia, inactivation of increased affinity for oxygen);

B) transplacental form - a consequence of a violation of the gas exchange function of the placenta due to its perfusion or diffusion insufficiency:

Late toxicosis;

Post-term pregnancy;

Premature placental abruption;

Extragenital diseases of the mother (DM, GB, HF, etc.).

2. Hemic form:

a) anemic form - a consequence of a reduced content of fetal hemoglobin (hemolytic fetal disease, feto-maternal or feto-placental blood loss, internal hemorrhages of various localization);

b) a form of impaired affinity for oxygen (congenital, drug, intoxication hemoglobinopathies).

Z. Hemodynamic hypoxia:

a) cardiogenic form - a consequence of malformations of the heart and large vessels, endocardial

fibroelastosis, decreased myocardial contractility, severe arrhythmias (low cardiac output hypoxia);

b) hypovolemic form - a consequence of a decrease in BCC;

c) a form of increased vascular resistance - a consequence of a violation of the patency of blood vessels (including the umbilical cord) and the rheological properties of blood (increased viscosity).

4. Mixed hypoxia - with a combination of 2 or more pathogenetic forms of fetal oxygen deficiency.

According to the flow, they distinguish:

1) Acute fetal hypoxia:

During pregnancy (less often) - with uterine rupture, premature detachment placenta;

During childbirth (more often) - with anomalies labor activity, prolapse or pressing of the umbilical cord, compression of the fetal head in the pelvic cavity.

2) Subacute fetal hypoxia - usually appears 1 - 2 days before delivery and is characterized by depletion of the adaptive capacity of the fetus.

3) Chronic hypoxia fetus - with a complicated course of pregnancy (preeclampsia, overmaturity, extragenital diseases, immunological incompatibility, infection of the fetus, etc.). It is caused by prolonged insufficient supply of nutrients to the fetus and is often accompanied by a delay in the development and growth of the fetus.

Diagnosis of fetal hypoxia:

1. Observation of the fetal cardiac activity:

1) Auscultation - allows you to detect gross changes in heart rate (tachycardia, bradycardia, arrhythmia).

2) ECG - change and lengthening of the P wave, prolongation of the PQ interval, ventricular complex, flat or negative ST segment, splitting of the R wave, etc.

H) PCG - a change in the amplitude and an increase in the duration of heart sounds, their splitting, the occurrence of noise.

4) Phase analysis of cardiac activity - a change in the phases of myocardial contraction.

a) initial signs of intrauterine hypoxia:

Tachycardia or moderate bradycardia;

Increase or decrease in rhythm variability, low-modulating type of curve, short-term (up to 50%) rhythm monotony;

Weakening of response to functional tests;

The occurrence of late decelerations in response to uterine contractions;

b) pronounced signs of fetal hypoxia:

severe bradycardia;

Monotony of the rhythm (over 50% of the recording);

Absence or paradoxical reaction to functional tests;

Late decelerations in response to uterine contractions.

To characterize the CTT during childbirth, a scoring is used for all parameters of the fetal heart rate.

2. Study of acid-base balance of fetal blood obtained from the presenting part of the fetus - an indicator of hypoxia is a decrease in pH:

a) in the first stage of labor, the lower limit of pH is 7.2;

b) in the second stage of labor - 7.14.

3. Observation of the motor activity of the fetus:

a) 5 or more movements within 30 minutes - the condition of the fetus is good;

b) restless fetal movement, manifested in the increase and increase in its activity - initial stage intrauterine hypoxia

c) weakening and cessation of movements during progressive hypoxia.

4. The study of the respiratory movements of the fetus using ultrasound.

5. Examination of amniotic fluid:

Visual - during hypoxia, the presence of meconium, meconium staining of water, a decrease in amniotic fluid are detected;

Biochemical - pH.

To successfully combat fetal hypoxia, it is necessary to treat the underlying disease of the pregnant woman, ensure an adequate supply of oxygen to the fetus, increase the resistance and endurance of its brain centers to oxygen deficiency, and create conditions conducive to the flow of metabolic processes. To solve these problems, first of all, it is necessary to influence the oxygen transport function of the placenta. This is achieved in several ways:

Expansion of uteroplacental and fetoplacental vessels;

Relaxation of the muscles of the uterus;

Normalization of recoagulation properties of blood;

Activation of the metabolism of the myometrium and placenta.

In the treatment of fetal hypoxia, the following groups of drugs are used:

1. Estrogens:

They are powerful regulators of uteroplacental circulation;

Expand the precapillary vessels of the uterus and the maternal part of the placenta;

Enhance the activity of uteroplacental metabolism;

They increase the permeability of placental vessels, increasing the intensity of the transition of glucose and other nutrients to the fetus.

2. Vasodilators and antispasmodics (eufillin, theophylline, complamin, curantin), beta-adrenergic agonists (partusisten, salbutamol, isadrin, etc.):

They have a tocolytic effect (relaxation of the myometrium and expansion of the uterine vessels);

Activate placental metabolism (stimulation of hormonal activity, acceleration of trophoblast regeneration);

3. Rheocorrectors and antiaggregants (rheopolyglucin, trental, chimes).

4. Anticoagulants (heparin).

5. Substances that directly affect the metabolism and energy of the placenta - small doses of insulin, vitamins ( folic acid, pyridoxine, cyanocobalamin, ascorbic acid, tocopherol), glucose, amino acids (glutamic acid, methionine), anabolic agents (sodium succinate, potassium orotate, inosine), etc.

It is possible to use oxygen therapy in the form of inhalation of mixtures with an oxygen content of 50 - 60%, HBO.

With fetal hypoxia, it is necessary to ensure the rest of the pregnant woman. At bed rest improves blood supply to the uterus.

Every newborn in the first moments of his life passes one of the very first and important exams. He is being tested on the Apgar scale. This unusual rating system was created specifically for doctors so that they can determine what condition the baby is in after birth. What is the Apgar scale and what do its scores say?

emergence

Apgar score appeared about 60 years ago, in 1952. Its founder was a woman, an anesthesiologist. At the annual convention, Virginia Apgar proposed the introduction of an objective system of assessments that indicate the condition of the newborn.

Initially, these data were intended for medical personnel of the middle category, on whose shoulders the responsibility fell to quickly determine the problems of the baby, and, if necessary, provide him with first aid. Over time, the Apgar score gained popularity among doctors and is now used in all maternity hospitals.

The essence of the system

This method is still the most accurate and objective indicator of the clinical condition of the child in the first and fifth minutes after birth. Thanks to these figures, doctors instantly understand that the baby needs resuscitation equipment or other restorative procedures.

The first assessment of newborns on the Apgar scale indicates the state of the body after the birth, the degree of asphyxia. The second indicator indicates how the baby has adapted to the world around him after 5 minutes.

Apgar scores are completely independent of the height and weight of the child. They evaluate other signs of his vital activity. Each letter indicates a certain indicator of the child's condition, namely:

• A (appearance) - skin tone;
• P (puls) - heartbeat;
• G (grimace) - movements, grimaces, scream;
• A (activity) - the state of the muscles;
• R (respiration) - indicator of respiration.

According to these parameters, doctors determine the well-being of the baby, whether he needs help. Points are awarded to each item - from 0 to 2. The summed Apgar score is entered into the card, the maximum value of which can reach 10 points.

Critical situation

Usually the second value of the scale is higher than the first. But there are times when after 5 minutes the total score does not rise more than 7 points. Then the question of taking emergency measures is decided. First, the neonatologist conducts additional procedures to check the baby's vital functions, which are done up to 20 minutes after the birth process.

If the child's health does not improve, and the indicators fall, resuscitation is urgently carried out by placing him in a special incubator.

There are frequent cases when a very weak child. On the Apgar scale, its performance can reach only 5 points. However, if the second score after a few minutes rises to 7 points, nothing threatens the life of the newborn, and his condition quickly stabilizes.

What does the Apgar score mean?

• 10 points: a very good indicator of the good health of the baby. He had an excellent delivery.
• 7 to 9: Most babies are born with these results. The assessment suggests that there is no cause for concern, the child needs simple care.
• From 4 to 6 points: a satisfactory indicator of the condition of the baby. Health at birth is poor, some resuscitation may be urgently needed.
• From 0 to 3: critical, extremely unsatisfactory condition of the child. Urgent resuscitation is needed.

Actions of doctors

It takes only 30-60 seconds for a professional obstetrician to take delivery to accurately determine the condition of the baby.

Modern newborns rarely get top marks. First of all it is connected with ecology. Basically, most of the little ones get 7-9 points, and this is considered a good result.

For each of the indicators, the doctor awards a certain number of points. The sum of five values ​​​​is the main assessment of newborns on the Apgar scale.

Causes of problems

In most cases, a low score on the scale indicates the child's hypoxia, or oxygen deficiency. This state has the following forms:

• Chronic hypoxia (formed while the baby is in the womb). The reasons are various pathologies during pregnancy, some malformations of the child.
• An acute lack of oxygen (this may be a one-time situation that arose only in the process of childbirth). The main reason for this form of hypoxia is a complication during contractions and delivery.

As a rule, full-term babies have higher Apgar scores than babies who were born prematurely.

Attention to the skin

A healthy baby looks perfectly clean. His skin is covered with primordial lubrication, which is a natural defense against exposure. environment. The shade of the integument can be light pink or bright red. This is considered the first sign of the baby's health, and he is awarded 2 points.

If the child's skin is very pale, there is a slight blueness of the limbs, the doctors give a score of 1. With severe cyanosis of the whole body, the doctor fixes a zero indicator.

Pulse

In a newborn, the heart beats rhythmically, with a frequency of 130-140 beats per minute. This indicates an excellent condition of the child, and doctors fix a score of 2 points.

• swallowing;
• sucking;
• prehensile;
• spontaneous crawling reflex.

Active actions of such a plan are shown by a healthy newborn. On the Apgar scale, he is awarded 2 points. If the reflexes are weak and uncertain, the indicator drops to 1, and if they are absent, 0 points are added.

muscles

A healthy newborn is born with increased tone in the limbs. This explains their posture - the head is bowed to the chest, the arms and legs are bent at the joints, the hands are tightly clenched into fists. The movements of the crumbs are chaotic, inconsistent, active. Such actions of the newborn are estimated at 2 points.

Slow movements and weak activity indicate little problems at birth. The child is given a score of 1 point. The complete absence of muscle tone indicates a critical condition of the crumbs. Zero mark is fixed in the map.

Breath

The baby announces its birth with a loud cry. These are excellent indicators, deserving 2 points. At the same time, he performs 40-45 respiratory reflexes per minute.

If the cry of the child is weak, appeared after a while, he is awarded 1 point. If there is no breathing, and the baby does not make any sounds, urgent resuscitation is necessary. The doctor awards 0 points.

Major scores ahead

Parents are very worried about low Apgar scores. But it should be remembered that they are not indicators of the health of the baby or his mental capacity in future. The Apgar scale serves to assess the condition and well-being of the baby only after birth and acts as a guide to action for doctors in especially critical situations.

How the baby will develop in the future depends on the parents, their care, love and attention. Of course, being an excellent student is very good, but it's best to just be healthy!

The technique, which is designed to determine the main features that characterize the condition of the newborn, was proposed by Virginia Apgar. She was indirectly related to pediatrics, as she was an anesthetist by profession. Despite this, she managed to develop universal way assessment of the most important signs of the baby, which received her name - the Apgar scale.

At that time, there was a question about the need to find a standardized approach to solving the problem regarding the need for resuscitation. This is especially true for the possibility of restoring respiratory function.

Dr. Apgar's idea is to apply the same assessment, but in dynamics, which allows you to give an adequate assessment of the care provided to the baby.

The scale proposed by Apgar includes 5 signs, each of which is determined twice - after the first and fifth minutes from the moment of birth. It is even intuitively clear that the norm on the Apgar scale is a higher number of points.

If the newborn has passed its first examination according to the criteria of this method, then the evaluation is completed. If the score is below seven, further monitoring is underway. The doctor monitors the condition of the crumbs every five minutes, that is, at 10, 15 and even 20 minutes.

Each criterion is scored, and the Apgar scale for newborns is presented in the form of a table. When they are summed up, a figure is obtained by which the health of the child is judged.

As a rule, it is sufficient to conduct an assessment at the end of the 1st and 5th minutes of life. If the baby has problems, an additional assessment is required.

Indicators of the state of the newborn

The main criteria that characterize the condition of the newborn are as follows.

Breath

Respiratory activity deserves the maximum rating if the number of movements during breathing is 40-45 per minute, and also if a loud cry of the baby is heard with the birth.

If at birth he is able to cry, but does not scream, but a trembling voice is heard and slow respiratory movements are observed, then a score of 1 point is given. In a critical situation, when there is no breathing and the baby does not make any sounds, the number of points is zero.

Heart rate

When the baby's heart appears from the mother's womb, it should beat often, since he had to work hard along with his mother. A score of two points is given at a heart rate of 130-140 beats per minute. It is generally accepted that a heart rate of more than 100 beats per minute deserves the maximum number of points.

If at intrauterine development oxygen supply was insufficient, slow breathing is observed, and the heart beats somewhat less frequently than normal. The score in this case is 1 point.

In the absence of a pulse, if cardiac activity is at an unsatisfactory level, points are not counted.

Muscle tone

Most often, newborns have an increased tone. This is due to being in the mother's womb in the only possible position. As a result, when the baby is born, freedom appears, and he makes chaotic sharp movements, which indicates a satisfactory muscle tone.

If the child holds the limbs in a bent state and moves only occasionally, then a score of 1 point is given. In the absence of movements at all, the score is 0 points.

reflexes

The newborn immediately triggers unconditioned reflexes, so he screams or takes his first breath. When they appear immediately, the score is 2 points. If you had to provide assistance and reflexes did not appear immediately, then put 1 point. In the worst case, there are no reflexes - a score of 0 points.

Color of the skin

In the ideal case, when a score of 2 points is given, the color of the skin of the crumbs is different shades pink. This fact indicates the normal state of blood circulation.

In addition, the mucous membrane of the mouth, lips, palms and feet are examined. If there is a slight cyanosis, then put 1 point. If the child has a pale or cyanotic color of the body, then the score is unsatisfactory.

Evaluation of a newborn using the Apgar scale should be done very quickly by the doctor, as delay can be very costly.

With a score of 7 or more, the baby's health is assessed as good, and he does not require special care. With 4-6 points, the need for resuscitation is not excluded. A score below 4 calls for urgent action to save the infant's life.

Apgar scale for newborns is presented in the table

How to interpret the score

Consider first the best option when they put the maximum score of 2 on all signs of the Apgar scale. To obtain such an assessment, the newborn must breathe on his own, and it does not matter how he does it, good or bad. It is important that he breathe.

The heart in this assessment should have a beat rate of more than 100 beats per minute, and the arms and legs are bent. At the same time, the baby actively screams, sneezes, responds with movements to various manipulations, and his skin is healthy pink.

With independent, but irregular breathing, an average Apgar score is given. At the same time, the heartbeat is heard, but it beats at a frequency of less than 100 beats per minute, and the hands and feet are bluish, but the face and body are pink.

In this case, the reactions during various manipulations are expressed by inactive grimaces, and the limbs are slightly bent.

In the worst case, points are not added, which indicates that the baby is not breathing, and the heartbeat is not heard, and the pose is not typical for normal state health (frog pose). In addition, it is observed complete absence reactions to actions, and the skin became cyanotic (total cyanosis).

When adding the number of all scores for each criterion, an Apgar score is obtained.

For clarity, consider an example. Let's assume that the newborn has appeared in difficult childbirth. At the end of the first minute of life, breathing was weak and irregular. When listening to the heartbeat, it was found out that its sound was muffled, and the frequency was 120 beats per minute.

The baby is in a semi-flexion position, and when he began to grimace while cleaning his nose and mouth, he received 1 point for this indicator. In this case, the bluish color of the child's body takes place. When adding the numbers of the set points, we get the sum equal to 5 points on the Apgar scale.

Doctors took resuscitation actions, and at the end of the fifth minute of life, the child began to breathe regularly, began to scream, and his heart began to beat at a frequency of 150 beats per minute.

Reactions to actions became active, the child sneezes, but the previous posture has not changed. The color of the body and face of the newborn became pink, but the cyanosis of the hands and feet was not completely gone. With sequential evaluation of all signs, an Apgar score of 8 is obtained.

This information is valuable for doctors in terms of the ability to assess the health status of a newborn over time, that is, in dynamics. If the value of the figure becomes higher, then the process of adaptation of the child is proceeding in a normal way, and those actions that carry out medical workers give a positive effect.

To be precise, there is no direct connection between the ongoing resuscitation actions and the Apgar scale. The neonatologist has two main tasks: to restore adequate breathing and to stabilize the heartbeat.

At the same time, using the Apgar scale, it is possible to predict probable pathologies. For example, studies have shown that there is a relationship between low grades, according to this method, and the frequency of neurotic disorders that occur in the later life of the child.

It is generally accepted that on the Apgar scale for newborns, the norm is 7 points or more. Strange as it may sound for amateurs in the field of pediatrics, it is impossible to get the highest score of 10 in the first minute of life.

Even if the child is healthy, then in the first minutes of life, the hands and feet of the newborn have a cyanotic color. Thus, this child can get no more than 9 points on the Apgar scale. However, it would be wrong to say that he is not healthy.

A similar situation can be observed with a sum of 7 points on the Apgar scale when evaluating three signs for an average score. For example, let it be about skin color, muscle tone and reflex reactions. In this case, the neonatologist judges the child's condition by such an assessment as completely normal.

Examples

For a deeper understanding, here are some examples of assessing the health status of a newborn, which is determined depending on the sum of the Apgar scores:

• 3-3 - the baby is in critical condition;
• 5-6 - close observation is necessary;
• 6-7, 7-8 - the state of health is at an average level, careful observation not required;
• 8-8 - the health indicators of the crumbs are above average;
• 8-9, 9-9, 9-10 - considered to be in good condition;
• 10-10 - does not occur in medical practice.

The presence of any indicator that differs from the norm and scores below 7-7 on the Apgar scale should not be taken to heart. These figures cannot indicate the presence of pathology or, even worse, disability.

When a baby is born, points play a certain role, but they do not have any effect on the future of the child. To illustrate the situation, you can imagine that the doctor at the appointment is interested in the Apgar score, since the child often catches a cold.

This indicator is important only at the time of birth and is necessary in some situations during the first year of life. After some time, these numbers will remain history, like the height and weight of a newborn.

Useful video about procedures with a newborn after childbirth

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The first month of a child's life - the neonatal period - is the most difficult and hard day him time. In turn, the most crucial stage of this month is the first week, and in it the first hours of life. The neonatal period is the time of the most intensive adaptation of the child to the conditions of the external environment. Immediately, from the first minute, everything here is unusual for him: a different way of breathing, eating, a different temperature, a lot of new stimuli. Successful adaptation in the first year of life largely determines the state of health of the child not only over the next months, but also for many years of life.

In children born to healthy mothers in physiological childbirth, the adaptation period, as a rule, proceeds relatively smoothly, but now no more than 30% of such babies are born. The vast majority of newborns belong to the "risk group". This means that they need careful, sometimes long-term supervision by a doctor and especially careful maternal care. Under these conditions, they are fully accustomed to the new environment and have every chance to grow up healthy. Immediately after birth, the baby is weighed, its height, head and chest circumferences are measured. These are very important criteria physical development. In addition to indicators of the physical development of a newborn, it is customary to evaluate the degree of his maturity at the time of birth. A mature baby is a child ready for extrauterine life.

There are external maturity criteria:

• Sufficient development of subcutaneous tissue;
• Elastic pink skin;
• Dense bones;
• The physique characteristic of a full-term baby.

But even more important is the functional maturity of the child, the readiness of all his organs and systems for extrauterine existence. It is judged, in particular, by how pronounced the child's most important innate reflexes are, how stable the rhythms of the heartbeat and breathing are, whether physical activity, readiness to digest food, etc.

To determine the condition of newborns, as well as to assess their physical development, there are special criteria. In maternity hospitals, the Apgar scale is usually used, according to which the main indicators of the child's condition are evaluated in points. The maximum possible score is 10, but this is rare, more often there are 9-8 points, which is also quite good. Do not be upset if the child received a lower mark. At good care and, if necessary, treatment, he will make up for it!

Good indicators of weight (mass) and height (body length) for boys are 3500-3700 g and 50-52 cm, for girls - 3200-3400 gi 48-50 cm.

The head circumference of a healthy newborn is usually 34 to 36 cm, 2 to 2.5 cm above the chest circumference.

In prematurely born children, indicators of physical development depend on the degree of their prematurity.

Transition states

First month- this is the time of the appearance of the so-called "transitional states", that is, situations, as it were, on the verge of health and illness.

• In the first days of life, there is a loss of body weight, which doctors call physiological, that is, natural. Its main reason is that the body of a newborn uses the reserves of nutrients received in utero, that is, it spends its "internal reserves". Normally, this weight loss after birth does not exceed 3-5% of body weight. By the 10th day of life, the child regains its original weight, and then the body weight increases. If the baby has lost more than 200-250 gi and has not recovered the loss by the 10-12th day of life, it must be shown to the doctor.
• Parents often worry that the child's skin suddenly acquires an icteric (icteric) tint. If jaundice is very mild, appeared on the third day of life or later, does not disturb the child's condition and disappears by 7-10 days, then this is - " physiological jaundice". There is no reason for alarm, since this phenomenon is due to the temporary immaturity of the liver enzyme system. But if jaundice - even mild - drags on for more long term, the question of the need to examine the child (sometimes in a hospital) should be decided by the doctor.
• Sexual crisis is one of the transitional states in a newborn. It appears as an increase mammary glands and swelling of the external genitalia in boys and girls. Sometimes a milk-like fluid is secreted from the mammary glands, and girls develop mucous or bloody discharge from the genital slit. This is the body's response to its release from maternal hormones.
• Breast swelling usually does not require treatment. If it is expressed significantly, you can apply a warming cotton-gauze bandage. In the presence of secretions from the genitals of the girl, it is necessary to wash it especially carefully with a slightly pink solution of potassium permanganate (“potassium permanganate”) or a weak infusion of chamomile - several times a day and always after a stool (defecation). The girl is always washed away, directing a jet of water from front to back.
• Transitional states also include transient, that is, quickly passing and insignificant, change (increase or decrease) in temperature, reddening of the skin, the appearance of white tubercles (“milia”) on the nose. All this pretty soon passes by itself and does not cause the child any noticeable anxiety.

umbilical wound

One of the most important processes in newborns is the rejection of the umbilical cord and the healing of the umbilical wound. After applying a metal or plastic brace at birth, healthy child there is a spontaneous falling off of the remainder of the umbilical cord on 3-5 days of life.

Usually, by the time the child is discharged home (4-6 days), the umbilical wound is covered with a bloody crust. Caring for this wound is one of the most important moments in the hygiene of a newborn baby. It is necessary to treat the crust twice a day (morning and evening, after bathing) with an alcohol-containing antiseptic (for example, 2% brilliant green solution or 1% chlorophyllipt solution).

Usually a crust with umbilical wound disappears by 12-14 days of a child's life. If the crust persists by the end of the 3rd week, or if, after it falls off, discharge from the wound reappears, a doctor's advice is needed.

Scabs on the head

Crusts on the baby's head are a minimal manifestation of a food allergy. As soon as the correct hygiene regimen and nutrition are selected for the child, the crusts will pass by themselves. It is strictly forbidden to comb the crusts with a comb, this can injure delicate skin child. You can smear the baby's head with sterile vegetable oil, wait, and when the crusts soften, carefully remove them with a cotton swab or soft sponge while washing the head.

Bathing

Basic hygiene procedure for baby- daily bathing, which, in addition to hygienic purposes, also provides soft hardening.

To bathe a newborn, you will need:

• Special baby bath (plastic or metal);
• Jug for rinsing;
• Thermometer for water;
• Terry mitten for soaping.

It is best to bathe your baby at the same time before one of the evening feedings. The water temperature should be comfortable - 36 _ 37 ° С. The bathing process itself takes 5-7 minutes. It is important to wash all the folds (with a hand soaped with baby soap). With a soapy terry mitt, it is enough to wash the body and head of the child once or twice a week.

Until the crust from the umbilical wound has fallen off, a 5% solution of potassium permanganate is added to the water (until a slightly pink color). If a child has diaper rash, rash, skin irritation, it is useful to add chamomile infusion, oak bark decoction to the water. After bathing and careful drying on the changing table, the skin folds are smeared with baby cream, cosmetic or sterile vegetable oil, and powdered with baby powder.

In addition to evening bathing, the child needs a morning toilet - before the second feeding, at 8.30-9.30 in the morning. At the same time, the child's face and hands are washed with a cotton swab with warm (35-36 ° C) boiled water, then dried with a gauze (or disposable paper) napkin. The eyes are washed with boiled water - from the temple to the nose, each eye - with a separate sterile cotton swab. The nasal passages are cleaned with cotton wicks slightly moistened with sterile vegetable oil. The child's morning toilet is completed by lubricating the folds (after washing) with baby cream or oil.

Both girls and boys need to be washed after defecation, then gently dry the genital area with a clean diaper and lubricate it 2-3 times a day - with baby cream or neutral oil (sterile vaseline or vegetable). Powder can be used.

Cosmetics for newborn skin care

Children's skin infancy is different characteristic features: it has a thin surface layer, a dense vascular network, undeveloped excretory ducts sweat glands. In addition, in children of the first 6 months of life, elastic fibers are absent in the skin, which are formed only by 2 years. Their absence is compensated by a large amount of moisture, which protects the skin from mechanical damage.

The permeability of the skin in children of the first 2~3 years of life is much higher than in adults, so many external drugs are not used in order to avoid toxic effects on the body. It has been established that the permeability of the skin changes significantly when it is inflamed. Substances that do not normally penetrate the skin freely “pass” through it in case of any damage. The permeability of the skin also increases with an increase in its moisture content.

The abundance of capillaries in the skin, the peculiar structure of the vascular wall in newborns allow microbes to easily penetrate through it. Skin pollution affects the general condition of the child. The newborn is acutely sensitive to skin irritation, which is often the cause of anxiety, sleep disturbance and appetite. Children prone to allergies react to all components of the applied cosmetics, which leads to the rigidity of the selection of skin care products.

Thus, the baby's skin needs additional protection, which can only be provided by special cosmetics.

Children's cosmetics are a special kind of cosmetic products intended for daily care for the thin and sensitive skin of the child, its protection from various adverse factors. The action of this cosmetics is aimed at preserving the natural protective layer of the skin and preventing skin diseases.

The main requirement for children's cosmetic products is safety. When using products for adults, the child is at risk of developing contact dermatitis due to skin irritation with chemical components.

The effectiveness of any remedy depends on the location of the inflammation, its nature, depth and prevalence. General rule says: the more acute the inflammation of the skin, the more gentle the effect of cosmetics should be.

Depth of impact modern facilities can be distributed in ascending order as follows: powders, lotions, agitated agents, ointments, compresses, creams, plasters.

In child care, powders are often used - powdered substances that dry and degrease the skin, protecting especially sensitive areas from diaper rash and irritation.

When applying powder, you must follow some rules. Powder is usually used after bathing or washing a child to remove excess moisture from skin folds. Do not apply this product directly to the skin. A small amount of powder is applied to a cotton swab or palm, then the baby's skin is powdered. Excess powder must be removed from the surface of the skin. Do not use this product along with oils or creams.

In the care of a newborn, an important place is occupied by fatty components that nourish and softening the skin. It is known that fats and substances dissolved in them penetrate the skin well, therefore fatty substances are part of cosmetics, including children's ones. Fat applied to the skin enhances its blood supply, accelerates the resorption of seals, and restores elasticity. To avoid irritating effects, the fats used, both animal and vegetable, must be chemically neutral. In cosmetic lines, such a dosage form as a cream usually prevails. As a rule, it contains, along with high-quality animal fat and vegetable oil, an aqueous phase, representing an emulsion in which water particles are in oil, and vice versa. The effect of such a composition on the skin depends on the proportion of oil and water. An oil-in-water mixture absorbs and evaporates water, so it cools the skin and eliminates inflammatory manifestations. Such creams are well tolerated, soften and nourish the skin.

Creams such as "water in oil" have a less pronounced cooling effect, do not dry, but nourish the skin well, restoring its properties. It is advisable to use these creams for superficial inflammatory processes flowing with dry skin.

It is advisable to use cosmetic oils to remove impurities from the surface of the child's skin or, if necessary, for massage. Do not use cosmetic oils to moisturize the skin - for this it is better to use special moisturizing creams and milk. Should not be used fatty products with inflammation and diaper rash.

When choosing a cosmetic product, it is always better to consult a doctor.

Chamomile flowers contain essential oil, which includes more than 40 organic components and many trace elements. They are used as antispasmodic, anti-inflammatory and antiseptic.

succession has a high content of ascorbic acid, tannins and is used in dermatology as an anti-allergic and anti-inflammatory agent, as well as for pustular skin diseases.

The main action of calendula is bactericidal, anti-inflammatory, wound healing. It also has antifungal and even antiviral activity.

Wheat germ is a powerful stimulator of growth and cell division. The high content of starch and vitamins in them has a protective, wound healing and softening effect.

Disposable diapers

IN last years disposable diapers are widely used all over the world. According to most doctors, their use is a positive factor. It is only necessary to change them more often, since moisture weakens the skin, makes it more vulnerable, and the longer the child's secretions come into contact with the skin, the more likely it is to be damaged.

A common belief is that in the first two weeks you need to use only gauze diapers, incorrect. In them, the skin can remain moist, and the newborn still does not know how to make it clear that he is uncomfortable or unpleasant. Disposable diapers can be used from the first days of a baby's life.

How to change a diaper correctly

Diapers should be changed when they are wet or dirty.

To do this, prepare: a clean disposable diaper, some water and cotton wool, a napkin, baby lotion or oil. Alcohol-free children's can be useful wet wipes. Everything must be prepared in advance. Do not leave your baby unattended on the changing table!

To change a diaper you need:

1. Lay the baby on a safe, flat surface. Unzip and unfold the used diaper, carefully lift the baby by the legs with one hand, and with the other, remove the old diaper.
2. Before putting on a new diaper, wash the baby's skin with mild soap, rinse with water, pat dry with a tissue and, if recommended by a doctor, apply a healing cream or ointment containing zinc.
3. Place a clean diaper under your baby's bottom. Lower the child's legs. Put on a diaper. Secure it by sticking reusable fasteners on colored stripe in front of the diaper. Reusable fasteners can be unfastened and fastened several times, adjusting the fit of the diaper.

When changing a baby's diaper, you should pay attention to the nature of the stool. In the first 3 days of life, a newborn baby passes the original feces - meconium (greenish-brown). In the following days at breastfeeding the stool acquires a golden yellow color, a sour smell, its consistency is usually creamy. With breastfeeding, stools usually occur 5-7 times a day, with mixed and artificial - less often and usually - a thicker consistency.