Zhallene Michelle E. Sanchez APGAR SCORING Prepared by: Zhallene Michelle E. Sanchez

APGAR SCORE The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborn’s adjustment to extrauterine life. is a practical method of systematically assessing newborns immediately after birth to help identify infants requiring resuscitation.

APGAR SCORE It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits.

APGAR SCORE The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order.

HEART RATE Auscultating the newborn heart with a stethoscope is the best way of determining heart rate; however heart rate also maybe obtained by observing and counting the pulsations of the cord at the abdomen if the cord is still uncut.

Respiratory Effort A mature newborn usually cries sponstaneously at about 30 seconds after birth. By 1 minute he or she is maintaining regular, although rapid, respirations. Difficulty might be anticipated in a newborn whose mother received large amounts of analgesia or a general anesthetic during labor or birth.

Reflex Irritability One of two possible cues is used to evaluate reflex irritability: either the newborn’s response to a suction catheter in the nostril or the response to having the soles of the feet slapped. A baby whose mother heavily sedated will probably demonstrate a low score in this category.

Muscle Tone Mature newborns hold the extremities tightly flexed, simulating their intrauterine position. They should resist any effort to extend their extremities.

Color All infants appear cyanotic at the moment of birth. They grow pink with or shortly after the first breath. The color of newborns thus corresponds to how well they are breathing.

Color Acrocyanosis ( cyanosis of the hands and feet) is so common in newborns that a score of 1 in this category can be thought of as normal. This means that the central portion (chest) is pink, but the extremities, particularly the hands and feet, are blue or purple.

Color Asses the pinkness of the fetal skin. Totally pink scores 2.

Color Cyanosis is not normal and indicates the need for treatment. It is due to the accumulation of desaturated (oxygen-depleted) hemoglobin.

Color Cyanosis due to airway obstruction is treated by opening the airway. Cyanosis due to inadequate ventilations is treated by ventilating the baby. In mild cases, cyanosis may be resolved by providing 100% oxygen to the baby.

APGAR SCORE CHART CRITERIA INDICATOR 1 2 Pulse Heart Rate absent 1 2 Pulse Heart Rate absent Less than 100 More than 100 Respirations Respiratory Effort Slow, irregular; weak cry Good; strong cry Activity Muscle Tone Flaccid, limp Some flexion of extremities Well flexed Grimace -response to catheter in nostril -slap to sole of foot Reflex irritability No response -Grimace -Cough or sneeze -Cry and withdrawal of foot Appearance Color Blue, pale Body normal pigment, extremities blue Normal skin coloring; Pink

SCORE 7-10 at 1 minute = vigorous infant 4-6 = mild-moderate asphyxia --- 100% O2 by face mask 0-3 = severe asphyxia --- intubation

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