A baby is assessed for its basic activity and general conditions immediately after birth. For this purpose, a scoring system called as APGAR scoring system was devised in the early 50s of the previous century making it easy for the doctors and even nursery to assess the general condition of the newborn and to make an in-time intervention in case of bad scoring.
What is an APGAR scoring system?
APGAR scoring system named after the doctor who devised it is a set or table of certain conditions which is seen in a newborn. If these are alright, the baby is given a maximum score; he is considered as safe and cannot achieve a minimum desirable score, may need further management and help in breathing.
The process of birth is a stressful and painful process not just for you but for the baby as well. As soon as the baby is born the doctor performs some simple tests to evaluate if the baby endured the process normally and is ready to enter the world or is special and intensive care is required to strengthen the baby.
In layman’s terms, these tests are just physical examination of checking the vitals of the baby right after the birth and then again within the first few minutes. Technically the test is known as the APGAR test, this test checks the following criteria:
- Appearance; the healthy child is pinkish but if the Appearance of the baby is bluish that means there is something wrong.
- Pulse; the normal pulse rate should be more than 100 beats per minute if otherwise is recorded then that is another red flag.
- Grimace; this records how quick and strongly the baby responded to foreign stimulus and cried.
- Activity; the baby should be moving limbs to show normal birth
- Respiration; if the cry of the baby is strong then that means the respiratory system is normal.
Interpretation of APGAR scoring
After marking each category we get a sum of these. The maximum score is 10 and is the main goal at the time of assessment.
- A score from 7 to 10 is considered normal
- An Apgar score between 4 and 7 means that the baby may need resuscitation. (This is the reason scoring is done at birth and then after five minutes again to assess the situation better)
- A score between 0 and 4 is considered as bad and it indicates neonatal resuscitation and assisted breathing.
These tests are graded as per set criteria and the score of the baby decides if the baby’s birth process was healthy and normal or the baby might have developed a syndrome or condition that need attention. If your baby’s score is not up to the mark then further tests might be advised.
The chart that stores the above mention detailed test scores and remarks is known as the newborn scoring chart.
APGAR scoring chart
An APGAR scoring chart is devised for the same purpose and helps in quick evaluation of the baby. This form is very important from the medico-legal point of view as well. In case of any unfortunate event or death of the baby, this form helps in proving the initial condition of the baby and saves the doctor and hospital from gigantic lawsuits.
This form is filled very carefully giving accurate information of the identity of baby and mother, mode of delivery, date and time of delivery and his Apgar score at the time of birth and five minutes later.
At the end of the scoring, a pediatrician has to comment on the overall condition and next possible steps to be taken.
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The word APGAR consists of five categories abbreviated. These are in the form of a table with following description.
A for Activity or muscle tone
- 0 for no activity
- 1 for flexed arms and legs
- 2 for active baby
P for Pulse or heart rate
- 0 score for no pulse at all
- 1 for heart rate less than 100/min
- 2 for heart rate greater than 100/min
G for Grimace or response to any stimulus
- 0 for floppy or no response
- 1 facial response to stimulus
- 2 for Prompt response
A for Appearance or color of skin at birth
- 0 score for blue color of the faces and extremities
- 1 for pink body and blue extremities
- 2 for pink body face hands and feet
R for Respiration or breathing
- 0 score for no breathing
- 1 for slow breathing, irregular breathing or chest in drawing present
- 2 for fast, regular and easy breathing