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Activity
A limp limbs flexed active movement
(Muscle tone)
Pulse
P absent < 100 /min > 100 /min
(heart rate)
cough or sneeze
Grimace (nose)
G (response to smell or foot absent grimace cry and
slap) withdrawal of
foot (foot slap)
Appearance body pink
A blue pink all over
(color) extremities blue
Respiration irregular
R absent good st
(breathing) weak crying
The test is generally done at one and five minutes after birth, and may be
repeated later if the score is and remains low. Scores 3 and below are
generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally
normal.
A low score on the one-minute test may show that the neonate requires
medical attention[3] but is not necessarily an indication that there will be
long-term problems, particularly if there is an improvement by the stage of
the five-minute test. If the Apgar score remains below 3 at later times such
as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-
term neurological damage. There is also a small but significant increase of
the risk of cerebral palsy. However, the purpose of the Apgar test is to
determine quickly whether a newborn needs immediate medical care; it
wasnot designed to make long-term predictions on a child's health.[1]
A score of 10 is uncommon due to the prevalence of transient cyanosis,
and is not substantially different from a score of 9. Transient cyanosis is
common, particularly in babies born at high altitude. A study comparing
babies born in Peru near sea level with babies born at very high altitude
(4340 m) found a significant difference in the first but not the second Apgar
score. Oxygen saturation (see Pulse oximetry) also was lower at high
altitude.[4]
A score is given for each sign at one minute and five minutes after the birth. If
there are problems with the baby an additional score is given at 10 minutes. A
score of 7-10 is considered normal, while 4-7 might require some resuscitative
measures, and a baby with apgars of 3 and below requires immediate
resuscitation.
The Apgar test is usually given to your baby twice: once at 1 minute
after birth, and again at 5 minutes after birth. Rarely, if there are
concerns about the baby's condition and the first two scores are low,
the test may be scored for a third time at 10 minutes after birth.
Five factors are used to evaluate the baby's condition and each factor
is scored on a scale of 0 to 2, with 2 being the best score:
Apgar Sign 2 1 0
It's important for new parents to keep their baby's Apgar score in
perspective. The test was designed to help health care providers
assess a newborn's overall physical condition so that they could
quickly determine whether the baby needed immediate medical care.
It was not designed to predict a baby's long-term health, behavior,
intellectual status, or outcome. Few babies score a perfect 10, and
perfectly healthy babies sometimes have a lower-than-usual score,
especially in the first few minutes after birth.
Keep in mind that a slightly low Apgar score (especially at 1 minute) is
normal for some newborns, especially those born after a high-risk
pregnancy, cesarean section, or a complicated labor and delivery.
Lower Apgar scores are also seen in premature babies, who usually
have less muscle tone than full-term newborns and who, in many
cases, will require extra monitoring and breathing assistance because
of their immature lungs.
The test is generally done at 1 and 5 minutes after birth, and may be
repeated later if the score is, and remains, low. Scores below 3 are
generally regarded as critically low, with 4 – 7 fairly low and over 7
generally normal.
Low scores at the one minute test may require medical attention, but are
not an indication of longer term problems, particularly if there is an
improvement by the stage of the five minute test. If the Apgar score
remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk
that the child will suffer longer term neurological damage. There is also a
small but significant increase in the risk ofcerebral palsy. However, the
purpose of the Apgar test is to determine quickly whether a newborn needs
immediate medical care; it wasnot designed to make long–term predictions
on a child's health.
Some ten years after the initial publication, the acronym APGAR was
coined in the US as a mnemonic learning aid: Appearance (skin
color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone),
and Respiration. The mnemonic was introduced in 1963 by
the pediatrician Dr. Joseph Butterfield. The acronym also exists in German
(Atmung, Puls, Grundtonus, Aussehen, Reflexe) although here the letters
have different meanings.