A Total Apgar Score Below ____ Indicates That the Baby May Need Medical Support Such as Oxygen.

Number 644 (Replaces Committee Opinion Number 333, May 2006. Reaffirmed 2021)

Committee on Obstetric Practise

American Academy of Pediatrics—Committee on Fetus and Newborn

This document reflects emerging clinical and scientific advances as of the date issued and is bailiwick to modify. The information should not exist construed as dictating an exclusive course of treatment or procedure to be followed. This document reflects emerging concepts on patient safety and is subject to alter. The data should not be construed as dictating an sectional course of treatment or process to be followed.

---

Abstract: The Apgar score provides an accustomed and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot exist considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is non equivalent to a score assigned to a spontaneously animate baby. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.

---

Introduction

In 1952, Dr. Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at i infinitesimal of age and the demand for prompt intervention to establish animate one. A 2d report evaluating a larger number of patients was published in 1958 ii. This scoring organisation provided a standardized assessment for infants afterwards delivery. The Apgar score comprises five components: 1) colour, 2) center rate, 3) reflexes, four) muscle tone, and v) respiration, each of which is given a score of 0, 1, or 2. Thus, the Apgar score quantitates clinical signs of neonatal depression such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at 1 minute and 5 minutes later on birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than vii 3. The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after nascence and the response to resuscitation if needed; however, it has been inappropriately used to predict individual agin neurologic outcome. The purpose of this statement is to place the Apgar score in its proper perspective. This statement revises the 2006 College Committee Opinion and AAP Policy Statement to include updated guidance from Neonatal Encephalopathy and Neurologic Event, Second Edition, along with new guidance on neonatal resuscitation.

The Neonatal Resuscitation Plan guidelines state that the Apgar score is

useful for carrying information about the newborn's overall status and response to resuscitation. However, resuscitation must be initiated before the 1-minute score is assigned. Therefore, the Apgar score is non used to decide the need for initial resuscitation, what resuscitation steps are necessary, or when to use them 3.

An Apgar score that remains 0 beyond 10 minutes of age may, however, be useful in determining whether continued resuscitative efforts are indicated because very few infants with an Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic issue three four 5. In line with this, the 2011 Neonatal Resuscitation Program guidelines state that "if you tin can ostend that no heart charge per unit has been detectable for at to the lowest degree ten minutes, discontinuation of resuscitative efforts may be appropriate" 3.

Neonatal Encephalopathy and Neurologic Outcome, Second Edition, published in 2014 by the Higher in collaboration with the AAP, defines a five-minute Apgar score of 7–10 as reassuring, a score of 4–6 as moderately abnormal, and a score of 0–3 every bit depression in the term infant and late-preterm babe 6. That certificate considers an Apgar score of 0–3 at 5 minutes or more every bit a nonspecific sign of illness, which "may exist one of the showtime indications of encephalopathy" 6. However, a persistently low Apgar score alone is non a specific indicator for intrapartum compromise. Further, although the score is used widely in upshot studies, its inappropriate use has led to an erroneous definition of asphyxia. Asphyxia is defined as the marked impairment of gas exchange leading, if prolonged, to progressive hypoxemia, hypercapnia, and meaning metabolic acidosis. The term asphyxia, which describes a process of varying severity and duration rather than an end point, should non exist applied to birth events unless specific bear witness of markedly dumb intrapartum or firsthand postnatal gas commutation can be documented based on laboratory testing 6.

---

Limitations of the Apgar Score

Information technology is of import to recognize the limitations of the Apgar score. The Apgar score is an expression of the babe's physiologic status at i point in time, which includes subjective components. In that location are numerous factors that can influence the Apgar score, including maternal sedation or anesthesia, congenital malformations, gestational age, trauma, and interobserver variability 6. In add-on, the biochemical disturbance must be significant before the score is affected. Elements of the score such equally tone, color, and reflex irritability can be subjective, and partially depend on the physiologic maturity of the infant. The score as well may be affected by variations in normal transition. For example, lower initial oxygen saturations in the get-go few minutes need not prompt immediate supplemental oxygen administration; the Neonatal Resuscitation Program targets for oxygen saturation are 60–65% at 1 minute and 80–85% at five minutes 3. The healthy preterm baby with no evidence of asphyxia may receive a low score only because of immaturity 7 eight. The incidence of depression Apgar scores is inversely related to birth weight, and a low score cannot predict morbidity or mortality for any individual baby 8 9. As previously stated, it likewise is inappropriate to use an Apgar score alone to diagnose asphyxia.

---

Apgar Score and Resuscitation

The 5-minute Apgar score, and particularly a change in the score between 1 minute and five minutes, is a useful index of the response to resuscitation. If the Apgar score is less than 7 at v minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes 3. All the same, an Apgar score assigned during a resuscitation is non equivalent to a score assigned to a spontaneously breathing baby ten. At that place is no accustomed standard for reporting an Apgar score in infants undergoing resuscitation later on nascence because many of the elements contributing to the score are contradistinct by resuscitation. The concept of an assisted score that accounts for resuscitative interventions has been suggested, but the predictive reliability has not been studied. In social club to correctly depict such infants and provide accurate documentation and data collection, an expanded Apgar score report form is encouraged Figure ane. This expanded Apgar score too may prove to be useful in the setting of delayed cord clamping, where the time of birth (complete delivery of the infant), the time of cord clamping, and the time of initiation of resuscitation all can be recorded in the comments box.

The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia. Many other factors, including nonreassuring fetal center rate monitoring patterns and abnormalities in umbilical arterial blood gases, clinical cerebral office, neuroimaging studies, neonatal electroencephalography, placental pathology, hematologic studies, and multisystem organ dysfunction need to exist considered in diagnosing an intrapartum hypoxic–ischemic issue v. When a Category I (normal) or Category Two (indeterminate) fetal middle rate tracing is associated with Apgar scores of 7 or college at 5 minutes, a normal umbilical cord arterial blood pH (± 1 standard deviation), or both, it is not consistent with an acute hypoxic–ischemic event 6.

---

Prediction of Outcome

A 1-minute Apgar score of 0–3 does not predict any individual babe's outcome. A 5-minute Apgar score of 0–3 correlates with neonatal mortality in large populations eleven 12, but does non predict private time to come neurologic dysfunction. Population studies have uniformly reassured u.s. that most infants with depression Apgar scores will not develop cerebral palsy. However, a low 5-minute Apgar score clearly confers an increased relative hazard of cerebral palsy, reported to be as loftier equally 20-fold to 100-fold over that of infants with a 5-minute Apgar score of seven–10 9 13 14 15. Although individual risk varies, the population chance of poor neurologic outcomes also increases when the Apgar score is 3 or less at ten minutes, 15 minutes, and 20 minutes 16. When a newborn has an Apgar score of 5 or less at 5 minutes, umbilical avenue blood gas from a clamped department of the umbilical cord should be obtained, if possible 17. Submitting the placenta for pathologic examination may be valuable.

---

Other Applications

Monitoring of low Apgar scores from a delivery service tin be useful. Private case reviews can place needs for focused educational programs and improvement in systems of perinatal care. Analyzing trends allows for the cess of the effect of quality improvement interventions.

---

Conclusions

The Apgar score describes the condition of the newborn infant immediately after birth and, when properly practical, is a tool for standardized cess 18. Information technology besides provides a mechanism to record fetal-to-neonatal transition. Apgar scores do non predict private mortality or adverse neurologic consequence. However, based on population studies, Apgar scores of less than 5 at 5 minutes and 10 minutes conspicuously confer an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy. Almost infants with low Apgar scores, notwithstanding, will not develop cerebral palsy. The Apgar score is affected by many factors, including gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic weather. If the Apgar score at five minutes is 7 or greater, it is unlikely that peripartum hypoxia–ischemia caused neonatal encephalopathy.

---

Recommendations

• The Apgar score does not predict private neonatal mortality or neurologic outcome, and should not be used for that purpose.

• It is inappropriate to use the Apgar score alone to establish the diagnosis of asphyxia. The term asphyxia, which describes a process of varying severity and elapsing rather than an finish signal, should non exist applied to nascence events unless specific show of markedly dumb intrapartum or firsthand postnatal gas exchange can be can be documented.

• When a newborn has an Apgar score of 5 or less at 5 minutes, umbilical avenue blood gas from a clamped section of umbilical cord should exist obtained. Submitting the placenta for pathologic exam may be valuable.

• Perinatal wellness care professionals should be consequent in assigning an Apgar score during resuscitation; therefore, the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (the College) encourage utilize of an expanded Apgar score reporting class that accounts for concurrent resuscitative interventions.

wesleythomong.blogspot.com

Source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score

Share this post