After the child is born, his condition is assessed by specialists using the special APGAR system. What does it mean?

What is the APGAR scale

This is a special formulation for determining the condition of the child immediately after birth. It deciphers like this:
A- (activity muscle) From zero to three points the child’s activity after birth is assessed. How he moves, struggles, screams and squirms in the hands of the obstetrician.
P- (pulse) The normal heart rate of a newborn is 130-140 beats/min. 2-3 points are given if the pulse is above 100 beats/min and is within the normal range. If the pulse is less than 100 or absent altogether, this is 1/0 points and resuscitation.
G- (grimase|stimulation) This is an assessment of the reflex response to touch and irritants (wiping, processing the umbilical cord, washing, feeding). If the reaction is immediately active - 2 points, a weak and sluggish reaction - 1 point, a reaction is completely absent - 0 points.
A- (appearance|color) The color of the baby's skin is of great importance; if it is pale beige and pinkish, then the APGAR score is 2-3.
If the skin color is pale bluish, but the baby is active and all organs are normal (this means it has not yet left the womb, it will take a day or two) they give 1 point.
Blue skin with little activity of the baby - 0 points.
R- (respiration) The cry after the baby leaves the mother's womb is also assessed on the APGAR scale. No. of points for an immediate cry or for a weak one. A point is also given for absence of screaming or breathing.

Example of APGAR scale indicator in points 0.2, 1.2, 2.2 - these indicators indicate that the child’s life is in danger.
2.3, 3.3 - the child is placed in intensive care.
3.4, 4.4 - the child’s unstable health condition requires monitoring.
4.5, 5.6, 6.6 - the child’s health condition is weak, but not dangerous.
5.7, 6.7, 7.8 - the child’s health is still weak, but stable and does not require observation.
8.8, 8.9, 9.9 - the state of health is normal. The child will gain weight and develop normally.
10.10 - ideal health of the baby (this practically never happens).


Statistics show an interesting fact that children born by cesarean section are rated much higher on the APGARA scale, since they did not suffer the complications that could occur during natural childbirth.

Apgar, who invented Apgar

What is the Apgar score? This is a simple, internationally recognized way to quickly assess the condition of a newborn in order to understand how much the baby needs emergency care and, if there are several newborns, which is not uncommon in large maternity homes, who to give priority attention to.

She proposed this useful tool at the 27th Congress of Anesthesiologists in 1952 doctor Virginia Apgar. It must be said that Virginia herself was a professional of the highest class, moreover, she became a highly qualified doctor at a time when medicine in the United States was exclusively “male territory.” So the respected anesthesiologist, who worked in obstetrics for a long time, did not even think of adding her name to the annals of history. However, 11 years later, Hungarian pediatrician Joseph Butterfield came up with a convenient mnemonic rule, linking one of the criteria for assessing the condition of a newborn to each letter of the Apgar surname.

• A ppearance - appearance (skin color);
• P ulse (Heart Rate) - child’s pulse (heart rate);
• G rimace (Response to Stimulation) - a grimace that occurs in response to irritation;
• A ctivity (Muscle Tone) - activity of movements, muscle tone;
• R espiration - breathing movements.

Virginia's surname turned out to be a successful acronym for other European languages. In German it is A tmung, P uls, G runtonus, A ussehen, R eflexe, in Spanish - A pariencia, P ulso, G esticulación, A ctividad, R espiración. There is no good mnemonic rule in Russian, so our obstetricians had to memorize the five criteria without any prompting.

What is assessed by the Apgar score?

So, the five indicators that Virginia Apgar identified are: breathing, muscle tone, reflexes, heartbeat and skin color. For each indicator, a score from 0 to 2 is assigned.

• If breath If the baby has a frequency of 40-50 sighs and exits per minute, and the cry at birth is loud and shrill, then such readings are considered at the level of two points. Weaker readings are recorded with 1 point. If there is no breathing, and therefore no cry in the newborn, doctors set the score to 0 points.

• Muscle tone determined by the child’s position in space, active chaotic movements of all limbs and head.

• A newborn baby simply needs vital reflexes associated with his further full life, namely: swallowing and sucking reflex. In the first minutes of life, the child can already reproduce elementary reflexes for sucking and swallowing breast milk, as well as reflexes for crawling and walking. If these reflexes are actively manifested in a child, the child receives the maximum score, and if these reflexes are more sluggish or not all expressed, then the child receives a score of 1 point. The absence of any reflexes in a child is assessed as 0 points.

• If heart rate child exceeds one hundred beats per minute, then it is assessed at the maximum score (2). If the baby's heartbeat is below one hundred beats per minute, it is scored 1 point. And if there is no pulse at all, then the score is set to 0 points.

• Deserves the highest score in this assessment baby's skin is pink or slightly bright in color, the skin is usually smooth without bruises and blue spots. If the skin is pale pink with a possible slight blue tint, then the Apgar score is set to 1 point. Too pale skin and visual absence of vital signs are scored 0 points.

Apgar table

	2 points	1 point	0 points
Breath	40-45 breaths per minute, clear, loud cry	Breathing is irregular, cry is weak	There is no breathing
Muscle tone	Expressed, active movements	Limbs bent	No movement
Reflexes	Reaction in the form of coughing, sneezing, loud screaming	Grimace, movements	No reflexes
Heartbeat	More than 120 beats per minute	Less than 120 beats per minute	Absent
Color of the skin	Red, pink	Blue limbs	Pale

Scoring is usually carried out in the first and fifth minutes of life, so there are always two Apgar scores, for example 8/9 points. For obstetricians and neonatologists, not only absolute indicators are important, but also the change in assessment - how much the child’s condition has improved in the first minutes of life.After all, the initial low score on this scale may be associated with a simultaneous situation at birth (acute hypoxia or asphyxia), or a chronic condition of the fetus (chronic hypoxia), or physiological immaturity.

What do Apgar scores mean?

Apgar score assessment This only gives doctors an idea of ​​how the baby feels right away . They make no further assumptions about the child's development, since they are practically independent of the initial score. But they know exactly what actions to take immediately.

• The condition of children who score from 7 to 10 points, are considered good or excellent and usually require routine care;

• those who dialed from 4 to 6 points, are in satisfactory condition and may require only some resuscitation procedures;

• those whose result below 4, required immediate assistance to save their lives.

The most common cause of a low Apgar score is hypoxia, a pathological condition associated with oxygen deficiency in the child during pregnancy and childbirth.

It should be remembered that Apgar score - subjective. Therefore, it cannot be said unequivocally that a child who received 10 points on the Apgar scale is healthier than a child who received 7 points. This only means that in the first case, the newborn breathes normally, his skin and mucous membranes are pink, he screams quite loudly, and his reflexes are well expressed. And in the second case, one or two signs were less pronounced, he could not scream too loudly, or cyanosis was noted - blueness of the skin.

As soon as the baby is born, he undergoes the first blitz test of independence in his life. Strict examiners are doctors who give scores on the Apgar scale and enter them in the child’s “diary” - an extract for the children's clinic.

At first glance, the test results look quite strange - 6/8, 7/9, 8/9... Let's figure out together what they mean. To do this, you need to understand what this mysterious Apgar scale actually is?

Back in 1952, the famous American anesthesiologist Virginia Apgar developed a special system for assessing the condition of newborns. Each letter in the APGAR test corresponds to a specific body function:

A (appearance) - skin color
P (pulse) - pulse
G (grimace) - grimaces
A (activity) - activity
R (respiration) - breathing

Apgar testing is a system for quickly assessing the condition of a newborn and determining the need for resuscitation measures. The test is a summary analysis of five criteria: skin color, heart rate, reflex excitability, breathing and muscle tone. For each item, the baby is given a score from 0 to 2. Then the results are summed up, and a total score is given from 0 to 10 points.

Evaluation by eye

The baby was born, screamed loudly, and actively worked with its arms and legs - that's a sure 2 points. If he starts to grimace, but breathes unevenly - 1 point. Of course, there are more accurate indicators of the condition of the newborn (for example, oxygen tension in the umbilical cord blood). But to determine this, you need to conduct a special analysis. And the Apgar scale makes it possible to fairly accurately assess the baby’s condition with the naked eye. Moreover, evaluate it in the first minutes of birth, which is very important. Often, help needs to be provided to the baby immediately, and there is simply no time for additional research.

An experienced doctor only needs 40-60 seconds to carry out the test, meaning he can determine the condition of the baby almost at lightning speed. If the baby scores low, he urgently needs medical help. However, test results may vary. To do this, it is carried out at least twice - at the 1st and 5th minutes after birth (hence the double score: for example, at the first minute 6, at the second 9, it turns out 6/9). It often happens that in the 1st minute the baby receives a very low score. But after resuscitation procedures, he gains the necessary points. The baby just needed time and help to adapt to new, unusual conditions. If during the second test, that is, at the 5th minute, the Apgar score is less than 7 points, the baby will be tested again every 5 minutes for the next 20 minutes and at the same time the necessary procedures will be carried out.

Apgar score: what are we testing?

Rating "Excellent"

10-9 points - the baby is healthy, all body systems are activated on time, and the newborn does not need medical attention.

Rating "Good"

8-7 points - the baby passed the exam, the doctors have no special reasons for worry (the baby suffered acute oxygen starvation, but then his condition stabilized).

Rating "Satisfactory"

6-5 - the situation is not very good, the baby will most likely be placed in the pediatric intensive care unit under the supervision of nurses. Here they will monitor the vital functions of the body. The baby will be brought to the mother when all body systems begin to work stably.

Rating "Poor"

4-0 points - the newborn needs emergency care, resuscitation measures must be taken urgently (since there is a danger to the child’s life).

	0 points	1 point	2 points
Color of the skin	Excessive pallor or blueness	Body pink, limbs bluish	Pink body and limbs
Number of cardiovascular contractions	No heartbeat	Less than 100 heartbeats in 2 minutes	100 or more heartbeats per minute
Reflex excitability (reaction to pumping out mucus)	No reaction	Displeased grimace, weak movements	Coughing, sneezing, loud screaming
Muscle tone	Absent, body relaxed, limbs hanging	The tone is reduced, the limbs bend	Facial expression: curled up into a ball, arms and legs bent
Presence of spontaneous breathing	Not breathing	Irregular single breaths, weak cry	Normal breathing, loud scream

Excellent and good students

Only 15% of newborns receive 10 points in the first minute. Most babies need some time for all body systems to work at full capacity outside the mother's body.

The borderline score is 7 points. In this case, a lot depends on the professionalism of the doctors and on how the baby adapts to new conditions. The first assessment indicates the amount of necessary assistance that needs to be provided to the baby. But this is in no way an indicator of the baby’s further development. But the second assessment can already predict health problems. Therefore, if the second score is low, the baby will be observed by a neurologist for the first year of life. The lower the second score, the higher the likelihood of damage to the central nervous system. As a rule, a low score is due to the fact that the baby experienced oxygen starvation, that is, was in a state of hypoxia (chronic hypoxia - oxygen starvation during pregnancy and acute hypoxia - oxygen starvation during childbirth). Premature babies often have lower scores than those born on time.

The Apgar scale makes it possible to fairly accurately assess the baby’s condition with the naked eye, and in the first minutes of birth.

Calm, just calm!

Apgar scores are included in the statement for the children's clinic, which is handed out to them. Many parents are frightened when they see that their child did not immediately become an "excellent student" and his grade is too low. Remember, it has nothing to do with the child’s intellectual potential, but only determines the baby’s condition right away. Parents' fears are sometimes excessive. Yes, such a baby will need more attention, you may have to take more massage courses and do therapeutic exercises with him. But it's not that difficult! Recent research by doctors confirms that most of these babies grow up quite healthy. In recent years, there has been a lot of controversy about how objective the Apgar system is. Thus, psychologists say that every baby has its own character and temperament from birth. Obviously, a baby who is more passive from birth will not actively move or scream loudly, and this does not mean at all that he is sick. Future quiet people will most likely just whine and quickly calm down. And the bullies and daredevils will scream loudly as soon as they are born. By the way, Virginia Apgar herself also called her system rather conditional. So it is premature to panic because of low indicators.

Apgar scores, along with height and weight, are the first and most significant in your baby’s life. During the first year of the baby's life, doctors will ask the mother what Apgar score he was born with. So memorize these two numbers and don’t forget: no matter who your baby is - an excellent student or a C student - he really needs your care and love. There are never too many of them.

Discussion

Thank you! Very good article - everything on the shelves. I have never come across such detailed information about the APGAR assessment. My first child was born 4/6 points - he almost suffocated during childbirth. When our pediatrician saw this assessment, she immediately asked why he was not breathing, and for a long time I wondered how she immediately realized that the low score was precisely because of breathing.

Comment on the article "First exam: Apgar score"

The Apgar scale is an assessment of the child’s condition in the first minutes of life, such as whether resuscitation or other procedures are needed for further development. And the Apgar scale is a special system for assessing the condition of a newborn in the first minutes after birth - by skin color, cry, frequency...

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First exam: Apgar score. Only 15% of newborns receive 10 points in the first minute. Most babies need some time for all body systems to work at full capacity outside the mother's body. Borderline score - 7 points.

First exam: Apgar score. Back in 1952, the famous American anesthesiologist Virginia Apgar developed a special one. Each of the letters of the APGAR test corresponds to a specific body function.

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Many young parents have encountered the expression “Apgar scale” in their lives. Immediately after birth, the doctor should inform the woman of the points he has assigned to the baby according to this scale. Just like height and weight, they are entered into the exchange card. These parameters are most needed by doctors, and not by the woman herself.

What is the Apgar score used for?

This system was developed by American anesthesiologist Virginia Apgar in 1952. The purpose of the scale is to provide obstetricians with the opportunity to evaluate a newborn baby immediately after he comes into this world. In this way, the need for resuscitation can be quickly determined.

The newborn is assessed on the Apgar scale twice - during the first and fifth minutes of life. In rare cases, more such assessments are required. Initially, nurses tested newborns' reflexes. But in our time this is the responsibility of a neonatologist.

Ten-point scale for assessing the condition of a newborn

A ten-point system is used to evaluate a child. In this case, the indicators of his pulse, breathing, muscle tone, skin are taken into account, and each of them is assessed separately, awarding from 0 to 2 points. Their sum is the result of the survey.

A newborn baby is weighed and his height, head and chest circumference are measured. If your baby was given a score of more than 7-8 points on the Apgar scale, the child is absolutely healthy. In this case, it stays with the mother until discharge. If the overall assessment is below 7 points, the child needs resuscitation care.

An Apgar score of 8/8 is quite good, since less than 15% of newborns score 10 points in the first minute.

Are the concepts of “viable” and “healthy” similar?

There is no need to panic or be upset if the doctor gives your child an Apgar score of 7/8. If the baby was immediately placed on his mother’s stomach, he was given breastfeeding and then taken for examination, he is viable. But the state of his health can only be judged based on the results of certain tests and examinations performed. A score of 8/9 and even 8/8 points on the Apgar scale is considered quite high.

They check, regardless of his mother’s wishes. Parents may be required to consent to vaccination, but no one will ask permission to conduct an examination.

During this examination, the doctor must draw blood from the big toe to rule out the presence of five common mutations. If they are detected in a timely manner, with proper therapy the likelihood of their cure increases significantly. In this case, the baby will be full and healthy.

Scheme for determining the overall score

The baby's condition is analyzed using the Apgar scale during the first five minutes of his life. Immediately after birth, they look at when and how the baby cried, examine the condition of his skin, evaluate him in the bright light of a flashlight, and determine muscle tone and heartbeat.

If the baby has a natural skin color and cried loudly without outside help immediately after being born, the baby receives the highest score on the Apgar scale. In addition, he must resist when the neonatologist bends or extends his limbs. In bright light, such a newborn winces, and the heart rate, according to the prescribed standards, is about 100 beats per minute.

The neonatologist also checks the presence or absence of unconditioned reflexes. If the child is placed on his back and the support is placed on his legs, he should push off. This is called the crawling reflex. When the child is taken under the armpits and placed with his legs on the table, while tilting him slightly forward, he must rearrange his legs, imitating walking. This is an automatic gait reflex.

Low Apgar score

But not every baby manages to show excellent results after passing through the birth canal and experiencing great stress as a result. Therefore, if the baby was given a score slightly lower than 8/8 points on the Apgar scale, there is no need to be upset, as this is the norm. In addition, we must not forget about the temperament of a newborn baby. After all, mothers can also be very calm. So why should a child be active?

As already mentioned, the child’s vital signs are assessed during the first and fifth minutes of his life. A fairly common case is when the first score is 1 point lower than the second. For example, an Apgar score of 8/8 indicates that the values ​​after 5 minutes have not changed significantly.

But quite often you can see slightly different values ​​in the exchange card. For example, 7/8 and 6/8 points on the Apgar scale indicate that after five minutes the baby has become accustomed to a completely unfamiliar world. Therefore, the indicators have become significantly higher. In most cases, during this short period of time, the body is saturated with oxygen, which improves the functioning of the cardiovascular system. This helps to add one or two points.

Newborn vital activity chart

To better understand what grades and why doctors give a newborn baby, you can use the table below.

Criteria for assessing a newborn using the Apgar scale

	2 points	1 point	0 points
State of muscle tone	The baby is mobile	There is insufficient activity of the baby	Lack of any movement
Breathing Features	The baby cried loudly on its own immediately after birth	Weak, irregular cry	No screaming and no breathing
Heart rate	> 100	< 100	Absent
Features of skin color	Light pink	The skin of the arms and legs is blue, the rest of the body has a natural color	The baby's entire skin has a blue tint.
Unconditioned reflexes	There is an excellent response to basic stimuli	The reaction to stimuli is poorly expressed, there is practically no mobility	There is absolutely no reaction to external stimuli

But with the help of this table you can only judge the physical health of the baby. Apgar scores cannot be used for other predictions. For example, it is not used to determine a child's mental abilities.

How to get a high score?

Of course, every mother wants her child to be healthy. 8 points on the Apgar scale is one of the most desirable indicators for her. But this result depends primarily on herself.

Immediately after a woman finds out that she is pregnant, she should analyze and adjust her diet and daily routine. You must also strictly follow absolutely all the doctor’s instructions. Only in this case, after 9 months, a strong and healthy baby will be born, who will receive at least 8 points on the Apgar scale.

Behavior during childbirth

You shouldn’t take doctors’ words during childbirth too lightly. After all, the way the child will be born depends on the favorable outcome of this process. The baby whose mother behaved correctly and followed all the doctor’s recommendations will receive 8/9 points on the Apgar scale. Otherwise, the baby may end up with a bruise instead of a head. There is, of course, nothing terrible or deadly about this. During the first month, the blue skin color will change to natural pink. But the Apgar score will decrease by 1 or 2 points.

Don't worry if some indicator was a little below normal. This does not indicate disability or the presence of pathological health problems. The Apgar score is a fairly important indicator that does not in any way affect the future of the child. It is taken into account only at birth, like height and weight.

Apgar score, is intended to assess the baby’s vital activity. Immediately after birth, each baby undergoes an examination that allows us to identify some parameters and repeats it at 3,5,10 minutes. The child receives Apgar scores, in which the work of the heart, breathing, reaction to external stimuli and muscle tension are assessed. Scores range from 0 to 10. However, even the highest score does not guarantee 100% ideal development of the child; the Apgar scale only gives an approximate forecast and assessment of the baby’s current condition. In medicine, the Apgar scale is used to determine whether it is safe for a child to be with his mother without the presence of specialists, or whether he requires medical attention.

The scale is named after the American anesthesiologist Virginia Apgar. The scale was first used in 1953, and since then it has become popular throughout the world.

What does the Apgar score reveal?

Immediately after the baby is disconnected from the umbilical cord, the neonatologist (pediatrician) checks the newborn for 5 aspects of health. Each feature scores from 0 to 2 points. The Apgar test is performed 4 times: in the first, third, fifth and tenth minute of life.

These 5 aspects include:

1. Color of the skin;
2. Heart rate;
3. Reaction to external stimuli;
4. Muscle tone;
5. The work of breathing.

Apgar score table.

The sum of the points revealed by the test shows the following results:

• 8-10 points - good condition of the newborn;
• 4-7 points - average condition of the baby;
• 3-0 points - asphyxia, medical intervention is required immediately.

Any newborn who receives a score from 7 to 0 points requires special intervention and observation.

However, it is worth considering that the child’s condition may improve in the next minute, so testing is repeated several times.

Apgar vital function assessment

The first aspect to be assessed is the child's work of breathing. After childbirth, leaving the mother's womb, the baby experiences extreme stress, since its environment changes radically. If a baby cries loudly immediately after birth, it automatically receives an Apgar score. If everything goes correctly, after a few minutes the newborn's breathing will be completely normal. If breathing is impaired, specialists give a special device with oxygen to normalize it. Premature babies most often experience breathing problems, since their organs have not yet reached a sufficient level of development. In addition, children get this disease after a difficult, long labor.

The next feature is the activity of the heart. If the newborn's heart rate is less than 60 times per minute, urgent resuscitation is necessary. Babies born vaginally are more tired and may appear duller in color than babies born via caesarean section. A newborn who receives a good score for skin color usually does not have problems with breathing and pulse, since these factors are interrelated.

The final assessment examines muscle tension and response to stimuli. If the newborn is healthy, then he is usually as mobile as possible, which proves good muscle activity. If the child’s body is flabby, and when trying to straighten it, there is no reaction, hypoxia or neurological disruptions are suspected. The response to external stimuli is carried out by inserting a special device (nasal catheter) into the nose. If the baby makes a face, coughs or sneezes, it means that the nervous system is developed correctly.