Apgar score 7 8 points what. First exam: Apgar score. How are the final indicators of CTG deciphered

Apgar score for newborns is a system for the first assessment of the health of a newborn baby. Doctors conduct such an assessment in the first minutes of life. The first Apgar score is given in the first minute after birth. The second assessment is set after 5 minutes. As a result, the Apgar score consists of two numbers that the doctor sets when examining a newborn.

The Apgar score allows the doctor to determine if the newborn needs special medical care. But besides the doctor, it is also important for the mother to know everything about the health of her child. In this article, we will tell you how to decipher the Apgar scale, what the scale points for newborns mean.

The system for assessing the state of the newborn is a table in which five main criteria for the state of health are entered, each scoring from 0 to 2 points. Apgar scores can range from 0 to 10 points. Let's look at the main criteria of the Apgar scale.

The main criteria for the state and functioning of the child's body, according to which points are set:

1. The work of the heart (HR) - count the heart rate per minute. In newborns, the heart works harder than in adults, so ideally the result should be 120-140 beats per minute.
2. Breath- the presence of breathing and its intensity is determined. Normally, a newborn takes 40-45 breaths per minute, accompanied by a piercing cry. With irregular and slow breathing, high scores (9.10 points) are not given.
3. Muscle tone- is estimated by the intensity of the motor activity of the newborn. The more active the newborn twists the legs and arms, the higher the Apgar score.
4. Reflexes of the newborn- the presence of unconditioned reflexes in a newborn is assessed (sucking, swallowing, grasping, etc.). But the main reflexes are a cry and a breath. If the child screams loudly, sneezes, clears his throat - that's good! If the child clings to the mother's breast and the fingers on the handles are tightly clenched into fists - this is also very good! There are other unconditioned reflexes that the doctor evaluates (read more HERE)
5. Color of the skin- the color of the child's skin is assessed, special attention to the palms, feet, lips and oral mucosa. With a pink color of the skin (from light to reddish), it is estimated at 2 points, if cyanosis of the skin is noticed - 1, pallor of the skin with a bluish tint - score 0.

Each criterion is evaluated, the scores are summed up.

Apgar scores

The scale for assessing the primary condition of newborns was developed by an American anesthesiologist Virginia Apgar. Apgar score was introduced into practice in 1952. Since then, all newborns have their own personal assessment at birth.

Naturally, the more Apgar scores a newborn received in total, the better. The best total score is 9 and 10 points. How to decipher Apgar scores?

Deciphering Apgar scores

As we already wrote, the assessment of the child's condition on the Apgar scale is carried out twice: at the first and fifth minute after birth. Most often, the second assessment is 1-2 points higher than the first assessment. This happens because the child has got used to it a little, adapted to new conditions for himself.

Apgar score 0

If the child was given 0 points, then the child was born dead.

1 point, 2 points on the Apgar scale

When assessing 1-2 points, the child's condition is regarded as extremely serious. There is a threat to the life of the newborn.

3 points on the Apgar scale

The condition of the child, assessed after 5 minutes at three points, is a critical condition. Baby needs resuscitation or other urgent medical attention

4 points on the Apgar scale

If the child was given a score of 4 points at birth, then the child's condition is regarded as serious. The newborn needs constant monitoring by doctors.

5 Apgar points

Five points is below average. The condition of the child requires medical supervision for at least 5-7 days. Medical assistance is provided according to the situation of examinations.

6 Apgar points

With indicators of 6 and 7 points, doctors conduct additional control examinations every 5 minutes for 20 minutes and look at the dynamics of changes. In this state, the child may need help for the child at any time (i.e. examinations are carried out at the 5th, 10th, 15th, 20th minute of the child's life).

Apgar score 7

In the first minute, an Apgar score of 7 is characterized as "no visible pathology", but better than 8, 9 or 10.

8 points on the Apgar scale

If the child was given 8 points even at the 5th minute, this is considered the maximum norm and the child is transferred to the mother.

9 points on the Apgar scale

Nine points at birth is a very good indicator. You have nothing to worry about, as the child's health is excellent!

10 points on the Apgar scale

An Apgar score of 10 at 1 minute is extremely rare. Ten Apgar points at the fifth minute say that the child's health is perfect!

10/10 points - does not occur in practice.

Newborn Evaluation Chart

Apgar results

According to the table, we can conclude: if the child was given 7, 8, 9, 10 points on the Apgar scale in the first minute of birth, and 8, 9, 10 points in the fifth minute, then this is good. With indicators of 7/8, 8/8, 8/9, 9/9, 9/10 or 10/10 points, you should not worry, the state of health is in perfect order.

Apgar results in 5/7, 6/7 and 7/7 points are not an indicator of the presence of a pathology in a child. These scores also do not indicate serious impairment or disability. These scores are about having certain problems. What exactly - the doctor will tell you about it. In addition, scores from 5 to 7 points require increased attention to the child. Your child will most likely need further testing.

But, in premature babies, the criteria score is lower than full-term ones, so a total score of 6 or 7 is a good result for them.

When assessing 5-6 points, the child needs careful observation by doctors, often special therapeutic measures are required. After discharge, the child is sent for examination to a neurologist.

When evaluating less than 5 points the condition is assessed as severe, hypoxia occurs. Most often, a newborn needs resuscitation. Such children are transferred to a hospital and are not discharged until a stable improvement in their condition. up to 7 points on the Apgar scale.

A low final result (up to 5 points) is a cause for concern for mothers and doctors. But the average Apgar score is 5 to 7. should not lead to panic- just such children need additional examination by a neurologist and other specialists. This indicator is important only in the maternity hospital and for the local pediatrician.

Understandably, every mom wants to hear about a 9 or 10 on this scale. However, you don’t need to waste your nerves, it’s better to take care of your baby!
In the future, this assessment, with proper care, will not affect the child's health in any way!

It is in accordance with the Apgar Scale, adopted throughout the world, that the first assessments of the baby are made immediately after his birth. Also, the grades are set in and are an information guide for the specialists of the district clinic.

In this article, we will figure out what exactly the Apgar Scale is talking about.

Apgar score. When is the assessment done?

A woman doctor, an American anesthesiologist named Virginia Apgar, proposed the use of a rapid assessment scale. First of all, her evaluation system is important for specialists in the maternity hospital, who monitor the birth of the baby and often make important decisions about the provision of emergency medical care.

Young mothers most often get acquainted with the concept of "Apgar score" at the time of receipt. Sometimes this acquaintance causes a desire to brag about the "achievements" of a child who was born an "excellent student" with a score of 10, and sometimes - an extra reason to be sad if the baby got offensive 6-7 points.

The newborn is tested on the Apgar Scale twice. For the first time - 1 minute after birth, the second time - 5 minutes after birth. At the 1st minute, the scores indicate how comfortable the baby endured himself. What the points show at 5 minutes indicate the quality of the baby's adaptation to the world around him.

There is another important point - the dynamics of estimated indicators. For example, if at the 5th minute of life the score is less than 7 points, additional measurements are taken every 5 minutes. Such careful observation is necessary until the general condition reaches a score of 7 points or higher.

If, on the 5th minute of life, the baby's score increases, for example, in the first minute - 5, and in the fifth minute - 7-8, the newborn is transferred to the category of children who are being monitored standardly.

Typically, a significant increase in the estimated scores can occur at 10, 15 and 20 minutes after birth.

Apgar score. How is the assessment carried out?

No special techniques using special equipment or analyzes in research laboratories are required. First, the newborn is completely examined by the doctor of the pediatric department - a neonatologist.

The check-up of a newborn includes the following mandatory points:

• General examination for the detection of external malformations.
• Examination of the skin of the child. Checking the symmetry of the folds.
• Inspection of the oral mucosa, in a newborn it should be pinkish and dry enough, since the natural secretion of saliva will begin only by 2 months of life. There should be no crevices in the sky.
• Assessment of heart rate with a phonendoscope. The norm is 130-14 beats per minute.
• Checking the baby's breathing activity.
• Measurement of the circumference of the child's head, usually it is 35 cm. The presence of a pulsation in the fontanel is also checked.
• Evaluation of the baby's facial expression (grimaces) - the tension of the facial muscles may indicate diseases. The slits of the eyes are the same, the eyes themselves are clean. Sometimes, as a result of prolonged labor, hemorrhage in the sclera can be observed.
• Inspection and palpation of the abdomen. The specialist checks how soft the stomach is, whether there are seals in it. The size of the internal organs is checked, the doctor finds out if the liver or spleen is enlarged.
• Examination of the genital organs. In a newborn girl, the large labia cover the small ones. In boys, the testicles must descend into the scrotum.
• Checking, lying on its side, the baby tries to take the embryonic position. If you pull the child by the handle or leg, he will begin to resist.
• Checking the integrity of the clavicle. If during childbirth the clavicle was broken, the cast is not applied.
• . The neonatologist spreads the baby's legs to the sides, while an angle of 90 degrees should form between the calf and the thigh.

Apgar score. What does he evaluate?

• Respiratory activity.

The first assessment of high-quality respiratory activity is the first cry of the baby. If it is sonorous and piercing, then the baby’s lungs have opened and everything is in order with the child. The baby breathes often, almost every second. That is, 40-45 breaths per minute are characterized by an indicator of 2. If the breath is knocked down, the number of breaths is less, and the cry of the baby is weak and uncertain, we can talk about the fact that the birth process was given to the baby with great difficulty, and he is physically exhausted. In this case, the infant receives a score of 1. If there are no respiratory movements and the child does not make any sound, a score of 0 is given.

• Heart rate.

In a newly born baby, the heart beats much faster than in an adult. The heart rate of a newborn can be 13-140 beats per minute. Therefore, if doctors note a heart rate of more than 100 beats per second, this important criterion is estimated at 2 points. 1 point is given to a child whose pulse has slowed down as a result of intrauterine oxygen starvation and has become less than 100 beats per minute. If the pulse rate is not audible, a score of 0 is given.

• Coloration of the skin.

Ideal baby skin should not be rough or dry. The folds of a newborn are without diaper rash and do not contain a large amount of primordial lubrication. The baby's skin color may be pale pink, pinkish, or bright pink. Any of these shades is worth 2 points. If the skin color is even, but cyanosis (cyanosis of the skin) is visible on the heels and palms, the baby gets 1 point. If the skin color is uniformly pale or bluish, a score of 0 is given.

You will soon be told to moisturize your skin, so look for the most natural products in Mom's Store.

Note. Return of food and cosmetics is possible only if the packaging is intact.

Children born into the world by way may have higher indicators for the condition of the skin, since they do not experience the difficulties that newborns may encounter in the process of moving through the natural birth canal.

• reflex excitability.

A person has 20 innate reflexes (including the first breath and the first cry of a baby), but only 7 are examined in the maternity hospital. The indicators of the development of these reflexes indicate the maturity of the brain and the excitability of the nervous system.

Specialists check the following:

Sucking and swallowing. These reflexes help the baby receive food from the mother's breast. If the baby is weakened, the sucking reflex may be weak.

Prepare thoroughly for breastfeeding and spending time from a few days to a week in the hospital. Doctors will carefully monitor the baby's weight gain, so try to establish breastfeeding as much as possible. Buy at Mom's Store:

• (according to the doctor's indications);
• and for comfortable feeding.

When shopping in we guarantee pleasant and fast service.

Upper and lower prehensile. They consist in the fact that if you put your finger in the child’s palm, he will be able to grab it tightly. If the specialist puts a finger under the toes on the baby's leg, the newborn will squeeze it tightly.

Walking and crawling. The stepper is checked as follows, the newborn is supported by the armpits and "put" on both legs. Leaning on a hard surface, the child begins to take real big steps, one after the other. As for the crawling reflex, if you put the baby on the tummy and put your palm under the baby's heels, he will begin to crawl, resting his legs on the palm.

"Fear" reflex. It is checked by stroking the heel of the child, while a healthy baby pulls the heel.

The newborn receives marks depending on the degree of expression of each of the reflexes, according to the results, an overall score is set. If each reflex is bright, the child gets 2 points, if any or several reflexes appear uncertainly, 1 point is set, the absence of reflexes is a reason to put 0.

• Muscle tone.

For newborns, increased muscle tone is the norm. The arms and legs are bent at the elbows and knees, the hands are clenched into fists, the head is slightly thrown back. In this case, the baby seeks to maintain the position of the embryo. The movements of the baby are not coordinated, he moves abruptly and chaotically. Such activity is estimated at 2 points, but if the movements are sluggish, the body is relaxed, and the limbs are only slightly bent, 1 point is set. Severe weakness of muscle tone and complete lack of movement is scored as 0 points.

It must be understood that Apgar scores do not reflect the future mental development of the child, and do not have the slightest connection with the future success or failure of the baby.

Apgar scores. What do they mean?

To assess the state of the newborn on the Apgar Scale, it is customary to use a 10-point system. Moreover, each of the five listed criteria (skin, heart function, etc.) can give from 0.1 to 2 points. Pronounced signs are evaluated at 1.5-2 points, insufficient at 1 point, and the absence or violation of signs is characterized by a score of - 0. Then the scores are summed up for all criteria and in total the total score of the baby can be from 1 to 10.

• 10 points is a score that doctors rarely give. She says that a physiologically mature newborn was born.
• 7-8 points indicate a good general condition of the child.

Newborns who score 7-10 points can be safely transferred to the mother or partners, in case. Such children do not require additional supervision, and all the necessary hygiene procedures, as well as the process of care and feeding, are completely assigned to the mother.

• 5-6 points most often indicate that the baby has not fully adapted to new conditions, a slight degree of hypoxia is possible. The child needs time to normalize all vital processes in the body.
• 3-4 points show that the condition of the newborn is unsatisfactory. There may be an average degree of oxygen starvation (hypoxia) and the child needs some resuscitation procedures. The baby will be under the constant supervision of the doctors of the children's department.
• 0-2 points indicate that the child suffers from asphyxia (suffocation) and he immediately needs life-saving resuscitation procedures. In particular, the stimulation of breathing.

Quite often, 5 minutes after birth, the baby's condition stabilizes, and its estimated indicators grow. This means that the baby is gradually getting used to life outside the mother's womb and becomes more active. Unfortunately, the prognosis for a baby whose performance declines after 5 minutes of life is less optimistic. This means that the child needs urgent intervention from the pediatric department and probably resuscitation.

Anna tells.After birth, according to the Apgar Scale, my son's score was 4. Serious entanglement of the umbilical cord prevented him from being born on his own, and the specialists decided to perform a caesarean section already during the contractions. The time count was literally seconds, and to my great joy, the doctors were on time. The second score that he received 5 minutes after birth was 6. Neonatologists did everything possible to ensure that the son began to breathe on his own. Nevertheless, the first day he was in a pressure chamber under the supervision of nurses.

I saw my son only 12 hours after the operation. Now my boy is 3 years old, fortunately, he is absolutely healthy. For the first half of the year we were observed by a pediatric neurologist, and I breathed a sigh of relief when, after the second visit, the doctor said that your son is in perfect order!

To summarize, scores of 7-10 points indicate that the baby was born healthy, 5-6 points - about slight deviations in health, the newborn's body was in a stressful situation, and he needs time to fully recover. 3-4 points require monitoring by the medical staff in the first days after birth and indicate average deviations in health. 0-2 points - reflect serious problems in the baby's condition.

Apgar score. Why might the ratings be low?

The more severe the general condition of the child, the lower his grades. As we have already said, most often the severity of the baby's condition is due to oxygen starvation, the acuteness of the situation when the baby suffers from hypoxia or even asphyxia. Timely resuscitation in most cases can correct this situation. But unfortunately, sometimes oxygen starvation causes irreparable harm to the child's body, in particular, various disorders of the nervous system.

Specialists combine such disorders with the term "perinatal encephalopathy" or PEP. Depending on the severity of brain damage in a newborn, a consequence of PEP can be:

• Syndrome of increased neuro-reflex excitability. It manifests itself in the form of shudders, trembling of the chin and limbs, general hyper (increased) or hypo (decreased) muscle tone, frequent causeless crying, restless, superficial sleep of the baby. Refers to the mildest degree of damage. Estimates of a baby with such manifestations do not exceed 6-7 points on the Apgar Scale.
• Syndrome of depression of the nervous system. As a rule, a baby with such a diagnosis has weak reflexes, in particular sucking and swallowing. The kids are lethargic, passive, their muscle tone is weakened, the kids are reluctant to eat and sleep for a long time. Sometimes these manifestations are accompanied by other abnormalities in the functioning of the body, in particular, the appearance of marbling of the skin, a violation of the heart rhythm and respiratory rate, problems in the gastrointestinal tract (constipation, bloating (colic), frequent regurgitation). This and the following syndromes refer to the moderate severity of brain damage and are estimated by experts at 4-6 points.
• Hypertension-hydrocephalic syndrome. Associated with the accumulation of fluid in the spaces of the brain. This causes an increase in intracranial pressure, and, accordingly, excessive "capriciousness" of the newborn. Experts can suspect such a deviation for several reasons:

1. the circumference of the newborn's head grows by more than 1 cm per week;
2. the baby's fontanel is enlarged and swells;
3. cranial sutures diverge;
4. the child is extremely restless, there are frequent regurgitation, sometimes even vomiting;
5. there is trembling of the eyeballs.

• Convulsive and coma syndromes. The most dangerous disorders of the central nervous system that require urgent intervention by specialists. In this case, the Apgar score ranges from 1 to 4 points. There are studies that show a relationship between low Apgar scores and the risk of epilepsy.

In addition to hypoxia, which was discussed above, the condition of the newborn is reflected in the mother's addictions and lifestyle, birth injuries or infections.

With proper care and competent medical supervision, most babies who have suffered a mild or moderate degree of perinatal encephalopathy have a complete recovery of the nervous system. Most often, such babies are under the close supervision of a pediatrician and a neuropathologist for some time.

It must be said that scoring on the Apgar Scale is largely a subjective process. Some of the specialists “famously give out” good grades, while others try not to overestimate the points once again. It cannot be said that a child who received a 9 or even 10 in the hospital is healthier than a baby with a score of 7 or 8.

It is important to remember that Apgar scores do not reflect the future mental development of the child, and have nothing to do with the future success or failure of children. To prove this, a number of studies have been conducted that have proven that any mental achievements of a child are influenced by the general atmosphere in the family, the social environment and the inner harmony of the baby, who at any moment is sure that he is desired and loved.

The first test that newborns (and most of those with good scores) take 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 general condition of the newborn and is based on observations in five rating 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 are in fair condition and may require only some resuscitation; and those whose result is less than 4 require immediate assistance to save their lives. At one time, it was believed that children whose scores remained low after 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 detect hypoxia and determine its degree, newborns are usually evaluated on the Apgar scale (see table below). The assessment is carried out at the 1-5th minute of life according to 5 clinical signs, each of which is estimated from 0 to 2 points. The maximum amount is 10, the minimum is 0. A score of 1 to 4 indicates severe hypoxia, and 5-6 indicates mild hypoxia. The sum of points 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 fact of the presence or absence of a state of hypoxia by the time of birth. If low Apgar scores orient the doctor to conduct antihypoxic therapy, including resuscitation, then a score of 7-9 points does not guarantee complete well-being. A few hours after birth, a deterioration in the condition may occur due to a syndrome of respiratory disorders or other pathology.

Apgar score table

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

Assessment of test results on the Apgar scale

This test is usually performed within the first to fifth minute after the baby is born, and may 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 medical staff to determine which children require more careful monitoring.

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

The child who received the scale 5-6 points a minute after birth, but five minutes later increased its rate to 7-10 , goes into the category of children you don't have to worry about.

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

The control of all indicators is carried out in the first minute after birth, then at the fifth minute of life.

In some cases, especially at low rates, the Apgar score is also given at the 10th minute of life. Babies who have had a caesarean section more often tend to score higher on the Apgar scale because they have no difficulty passing through the birth canal.

Mom and relatives are usually told two numbers, for example, 8-9 or 9-9 Apgar scores indicate that the condition of the child 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 average points - does not require close observation

8-8 points above average.

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

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

The Apgar score is given to every newborn baby in the first minutes of his life. This indicator plays an important role in the further diagnosis of the baby. Next, we will consider what this scale is, according to what criteria doctors rate.

In contact with

What it is

Many young mothers, when discharged from the hospital, do not know what the “Apgar scale” is, and do not understand whether everything is fine with their baby. We will try to dispel some myths and figure out what criteria are used to assess the health of a newborn on the Apgar scale and what this means.

Important! Since 1952, the concept of the "Apgar scale" has appeared in medicine.

This is an indicator by which the state of health of a newborn child is tentatively set. This term and method of assessment was introduced by a doctor from America.

The abbreviation APGAR has a decoding, which explains by what criteria the condition of the newborn is assessed on a scale:

• A (appearance) which means "appearance" in translation. That is, according to this criterion, the child's skin color and his general condition are determined.
• P (puls) is a measurement of heart rate.
• G (grimace) - facial expression and grimace.
• A (activity) - mobility, activity, general muscle tone.
• R (respiration) - reflexes and breathing.

All these indicators allow us to assess the condition of the baby and describe his reaction to the ectopic environment. The scale has 10 points. Thus, the health of a newborn child is estimated from 0 to 10 points.

Since the study of the child is carried out twice, two values ​​\u200b\u200bare entered in the card, for example, 7-8 or 8-9, etc. This indicator should be recorded in which will later be pasted into the baby's card. These numbers are needed by the pediatrician to understand the condition of the child.

How points are calculated

What do the numbers mean? The first grade is based on the health of the newborn in the first minute of life whether it was a natural birth or a caesarean section. If the baby does not have any reflexes, then 0-1-2 points are set, and resuscitation measures are taken. After that, a health assessment is again carried out.

As already mentioned above, the examination is carried out in the first and fifth minutes of life. If the last measurement below 7 points according to the Apgar scale, then every five minutes it is necessary to conduct an additional examination in order to track the dynamics of changes in health. If the condition improves, then there is no reason to worry, if it worsens, additional stimulation and resuscitation is required.

Points are considered as a whole, starting from all five criteria. That is, based on the examination of the skin, reactions, facial expressions, pulse rate, the average total score is determined.

In the first minute, 7-8 points on the scale is considered normal, by the fifth minute 8 or 9 points is an almost ideal state of health.

According to statistics, children with low Apgar scores catch up very quickly, provided proper care, feeding, and hygiene.

It is important to feed the baby in the early days . If this is not possible, then doctors will advise a quality adapted formula, which is also rich in vitamins and minerals, like mother's milk.

Norm and deviations

In the first minute, 10 Apgar points is a rarity. This result is found in 15% in the world and 5% in our country. Most Common Value 7-9 points and such children do not need special activities. Enough regular care and proper feeding.

If at birth no heartbeat observed or the pulse is too slow, there are no reflexes, then no more than 3 bp is set. After resuscitation, re-evaluation is carried out.

4-6 points exhibited to those children who inadequately respond to stimuli, the pulse is less than 100 beats. With massage and proper medical care, it is possible to restore the condition in the first five minutes and evaluate it at 7-8 points.

If a newborn has a low score at birth, this may mean that in the future it will be necessary to undergo a diagnosis of the whole body and prescribe treatment.

Only in this case can we hope for a good forecast.

Although there are exceptions, the code for 1 minute the baby has 3 points, and by the fifth - the tenth already 7, which is considered a satisfactory or even good result.

Most often, low results are associated With , that occurs during labor.

The pediatrician assesses the newborn on a scale. The process itself takes literally half a minute and this is enough to check the baby for all reflexes.

Apgar score of newborns in the table

According to the presented criteria, doctors of children evaluate. For example, when a baby has all the indicators in the norm, then for each criterion he scores 2 points and as a result gets 10. Most often, Apgar scores 8 in the first minute in children due to the cyanosis of the skin. The color darkens a little due to the fact that the waters leave much earlier than the baby is born, so he may have a lack of oxygen. If the birth went well and there are no congenital pathologies, then the upper layer of the epidermis turns pink in a matter of minutes. It is because of this that the result is always higher at 5 minutes.

In premature babies, the results are always lower, and this not considered a deviation.

Breath

Breathing is one of the first to be assessed on the Apgar scale, since this is one of the most important criteria for vital activity:

• If breathing is synchronous and uniform without any interruptions, then a high score is set and the doctor proceeds to measure the pulse.
• When the baby is breathing on its own, but there are interruptions or convulsions, the score is low, and you need to immediately ventilate the lungs.
• If there is no breathing, the child is rated at Apgar 0 and resuscitated. First, they try to start the work of the lungs with the help of an oxygen bag, but if there are no results, then the newborn is transported to intensive care and connected to an artificial respiration apparatus.

The child may breathe differently. He has not yet developed lungs and it takes time to fully breathe. A healthy baby should do on average about 42 breaths.

Heartbeat assessment

There are several methods by which the heart rate of a newborn is estimated, which are used by pediatricians:

• listening;
• palpation of the cavity on the chest;
• palpation of the pulse in the arteries.

The physician palpates 6 seconds and then multiplies the figure by 10 to get the result in a minute.

The 6 second method is relevant only when the child has even and full breathing.

Assessment of the upper layer of the epidermis

If the skin is excessively blue, this indicates a lack of oxygen. In this case, it is necessary to provide the baby with oxygen inhalation until the natural skin color is fully restored.

When the skin is pink or with a slight blueness, this is normal. In this case, they put from 7 points on the Apgar scale and put the baby on the mother's chest, or put on the father's chest, in case of surgery.

Useful video: what is the Apgar scale

Conclusion

In summing up, it is important to note that the Apgar scale is one of the most important criteria by which doctors assess the condition of a child in the first minutes of his life. This does not affect further development, physical or mental development. This is a purely individual indicator that makes it possible to understand the reaction of the newborn to the external environment, outside the mother's womb.

In contact with

In this article:

For more than 60 years, our newborn babies have been taking their first test - an assessment of their condition on the Apgar scale. What is it and what is it for?

62 years ago in 1952, the first American female professor, master of health, director of the division of the National Foundation for Birth Defects - Virginia Apgar proposed a system for determining the condition of newborns in the first minute of life according to a 10-point system - "Newborn Apgar Assessment". For ease of remembering the evaluation criteria, I used the initial letters of my last name:

1. A- appearance of the child (skin color);
2. P is the child's pulse (HR);
3. G- grimace, (reaction in response to an irritant);
4. A- activity and muscle tone of the baby;
5. R - respiratory movements of the child.

Each criterion is evaluated by a number of points from 0 to 2. The sum of points determines the state of the child 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 in order to be able to quickly respond and determine which of the babies needs emergency help in urgent medical procedures, or just closer attention.

Scoring methodology

The number of points evaluates and summarizes the reaction of the baby in the first minute of life (in the ectopic environment) - the restoration of violations of important body functions, measures aimed at restoring a possible failure of heart contractions, and respiratory failure during childbirth. Each of the five criteria is assigned points - 0, 1 or 2 points. The best total indicator is - 8, 9, and 10 points.

The score on this scale is determined at 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 to himself. If the sum of points at the fifth minute of the child's life does not exceed -7, within 20 minutes, a control examination is carried out every 5 minutes.

• The Apgar score of 7, 8, 9 and 10 points characterizes the state of the newborn without visible pathologies. Very few children get the maximum score - 10, mostly - 7/8 and 8/9 points. The second mark, given by the fifth minute, is usually 1.2 points higher, though not always. It can remain, for example - 8/8 or 9/9. Such children are immediately applied to the mother's breast and placed under her care.
• The state of the newborns, rated at 6 points, is evidence of unsteady breathing, decreased muscle tone, weak response to stimuli with a pulse rate of 100 beats/min or more. This condition is evidence of an average degree of asphyxia (lack of oxygen). The condition, rated 6 points, is considered satisfactory, but requires certain therapeutic measures.
• Urgent resuscitation - measures to prevent the development of complications or save lives, require babies whose condition is estimated from 4 to 6 points.
• The result according to this system at the first minute of birth is from 0 to 3 points, evidence of a slow pulse, change or lack of respiration, the skin is pale, muscle atony is noted. 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 was formed during pregnancy, or oxygen starvation that occurred during childbirth.

The cause of chronic hypoxia can be:

• Pathology of pregnancy;
• Possible malformations of the fetus.

The cause of acute hypoxia is a different degree of complications during childbirth.

Not always a low assessment of the criterion can lead to disastrous results. Positive dynamics in the state of the baby, 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, these children are quite normal and healthy, only some may need treatment or observation by a neurologist.

Premature babies have a criterion score lower than full-term babies and it rarely exceeds 6 points. But do not be upset by the lack of 9 or 10 points, because this test is purely preliminary, 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 them. They can be the result of many other factors - injuries or infections.

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

Most children with scores of 6/7 who have had a mild, moderate or even severe form 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

The work of the heart

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

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

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

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

• Children whose heart rate is less than 100 beats per minute are artificially ventilated with oxygen until the heart rate returns to normal.
• With a heart rate result exceeding 100 / sec. - the condition of the skin is assessed.

Breathing rate

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

• If the child is not breathing, in the conditions of the maternity operating room, in order not to lose precious time, he is ventilated with the help of the Ambu bag - a mask is applied to the mouth and nose, and air is manually pumped into the baby's lungs with the help of a rubber bag. After providing first aid and stabilizing the child's breathing, he is transferred to the rehabilitation unit.
• With convulsive, shallow, or irregular breathing, a lung ventilation procedure is performed. In such non-standard situations, high -9/10 indicators are out of the question.
• If breathing is spontaneous and regular, heart rate and Apgar readings are assessed. It can be indicators 7/8 or 8/9.

Muscle Tone Assessment

If everything is normal with the newborn, having just been born, he seeks to get rid of the “embryo” pose and, feeling freedom, actively swings his arms - he gets 2 cherished points.

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

Reflex evaluation

Despite his helplessness, thanks to innate reflexes, a newly born baby already knows a lot. Pronounced 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 severity is limited to +1, and the complete absence of reflexes = 0.

Skin color

Ideally, pale pink or hot pink newborn + 2 points. Thus, a combination of 2 points of all five indicators leads to an ideal variant = 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 total score that the newborn has earned is entered into the child's card upon discharge from the hospital. It is an indicator for the local pediatrician to immediately pay attention to possible problems in the health of the baby. According to these results, a schedule of vaccinations is drawn up and closer medical care is provided.

Don't worry about low scores. Apgar assessment of a newborn with a standard of 10 points is not an indicator of his development and an assessment of intellectual potential. Care, love and attention will allow the child to continue to receive excellent grades, regardless of those that he received in the hospital.