Apgar Index - Your Child's First Exam

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Philippe Gloaguen
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Apgar index, what it is and what it indicates

Immediately after the birth the newborn is subjected to a series of checks aimed at photographing his state of health. Doctors use a shared evaluation system called Apgar index.





The Apgar index is a test designed by an American neonatologist that allows you to quickly establish a first judgment regarding the most important functions of the baby's organism. It is carried out on the basis of five vital signs which are heart rate, respiratory rate, reaction to stimuli, skin color and muscle tone.

Each of these elements, at the time of the first checks after birth, receives a score from 0 to 2. If the sum of the parameters is greater than 7, the newborn is in excellent condition, if the Apgar is low it does not mean that the baby has serious problems, but the doctors intensify the post-natal checks to see clearly. 

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In this article

  • When you do
  • Acronym
  • Guidelines
  • How to do it
  • Results
  • Why do you do it
  • Autism

When you do

The peculiarity of this test is that it must be performed within 1 minute of birth and repeated after 5 minutes. It is to all intents and purposes the first visit that the baby makes once it comes out of the mother's womb.



It is important to do this immediately to analyze the health of the baby and, in the worst cases, to intervene promptly with resuscitation or other neonatal tests.

Apgar Acronym

Not everyone knows that the Apgar index takes its name from Virginia Apgar, an American doctor who invented this newborn test in 1952. A very important parameter that, many years ago, was useful for doctors and nurses present in the delivery room to understand if the newborn needed resuscitation. In the past, in fact, it happened not infrequently that the child appeared healthy and then died a few minutes later.

The name of the doctor and the 5 parameters evaluated at birth became, even for a simpler memorization, an acronym: 

A: Appearence (colorito)
P: Pulse (heart rate)
G: Grimace (reflections)
A: Activity (muscle tone)
R: Respiratory effort

Guidelines

Doctors, nurses, midwives are ready, at the moment of a woman's birth, to proceed with the Apgar index on the newborn. The baby will have the 5 parameters listed above checked within one minute of birth. Each parameter will be assigned a score that varies from zero to two depending on the baby's reaction to the stimuli and his physical appearance. But based on what? Specialists obviously have guidelines to orient themselves and understand if the newborn is in excellent health or not.

Below in detail all the indications followed by the specialists for the calculation of the Apgar index.

How to do it

The heartbeat is auscultated, the rhythmic frequency, the force of contraction of the heart are evaluated: the score is equal to zero if there is no heartbeat, equal to 1 if the heartbeat is there but is less than a hundred, equal to 2 if the heart rate it exceeds one hundred beats per minute and is therefore regular

Muscle tone is then established, therefore, the degree of normal contraction of the muscle at rest: the score is zero if the muscle tone is absent, 1 if the newborn just keeps the limbs flexed, 2 if the child keeps the limbs in natural flexion.

The complexion is checked: is equal to zero if the skin is cyanotic, equal to 1 if only the extremities are cyanotic, 2 if the complexion is pink.

The baby's reflexes are monitored: the score is equal to zero if there are no reflexes, equal to qa 1 if the baby hints at small mimic movements, 2 if it is lively, crying, sneezing.

Finally, the respiratory function is checked: the score is zero if no respiratory act is found, it is 1 if it is mild, it is equal to 2 if the breathing is effective and the baby cries.

How to interpret the results

The scoring of all these parameters gives life to the Apgar index. As a guideline, doctors, nurses, midwives know that a score lower than 4 requires resuscitation, a score between 4 and 6 is to be monitored with further tests and to be repeated in Apgar after a few minutes. A score between 7 and 10 indicates a healthy newborn.

Why is it done?

The Apgar index is performed in order to be able to quickly establish the degree of health of the newborn and decide, just as suddenly, how to intervene if the case requires it.

As anticipated, in fact, if the index is between 7 and 10 there is no need to make further immediate checks. The baby is fine and all the functions of his organism react perfectly. However, if the index is low, doctors will need to do further research. The low index could be generated by the type of birth, for example: with a caesarean section, in fact, the newborn is initially assigned (often, not always), an initial low score. This may be due to the anesthesia given to the mother, but after 5 minutes the re-evaluated Apgar should return to normal. There are other cases in which the problems of the newborn are already known, since the months of pregnancy (malformations, genetic diseases) and these are decisive at the time of the evaluation of the Apgar. 

And there are other situations in which the low Apgar index immediately makes the experts understand the seriousness of the situation and that it is necessary to intervene promptly with resuscitation or other types of assistance. 

In short, it is a fundamental exam, the first and also the most important for every newborn.

Apgar index and autism

There is no definite connection between the Apgar index and autism. Even infants with an Apgar 10/10 index can have autism spectrum disorders over time. The Apgar index is, in fact, inappropriate for predicting specific neurological outcomes in term babies.

The purpose of the Apgar test, we reiterate, is not to diagnose neurological problems, but to immediately determine if a newborn needs immediate medical attention.

It will be the doctors, if necessary, to request further tests on the newborn in the weeks, months, following the birth.

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