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 outcome 3 4 5. Neonatal Encephalopathy and Neurologic Outcome , Second Edition, published in by the College in collaboration with the AAP, defines a 5-minute Apgar score of 7—10 as reassuring, a score of 4—6 as moderately abnormal, and a score of 0—3 as low in the term infant and late-preterm infant 6.
However, a persistently low Apgar score alone is not a specific indicator for intrapartum compromise. Further, although the score is used widely in outcome 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 significant metabolic acidosis. The term asphyxia, which describes a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be documented based on laboratory testing 6. It is important to recognize the limitations of the Apgar score.
There are numerous factors that can influence the Apgar score, including maternal sedation or anesthesia, congenital malformations, gestational age, trauma, and interobserver variability 6. In addition, the biochemical disturbance must be significant before the score is affected. Elements of the score such as tone, color, and reflex irritability can be subjective, and partially depend on the physiologic maturity of the infant.
The score also may be affected by variations in normal transition. The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity 7 8. The incidence of low Apgar scores is inversely related to birth weight, and a low score cannot predict morbidity or mortality for any individual infant 8 9. As previously stated, it also is inappropriate to use an Apgar score alone to diagnose asphyxia.
The 5-minute Apgar score, and particularly a change in the score between 1 minute and 5 minutes, is a useful index of the response to resuscitation.
If the Apgar score is less than 7 at 5 minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes 3. However, an Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant There is no accepted standard for reporting an Apgar score in infants undergoing resuscitation after birth because many of the elements contributing to the score are altered 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 order to correctly describe such infants and provide accurate documentation and data collection, an expanded Apgar score report form is encouraged Figure 1.
This expanded Apgar score also 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 heart rate monitoring patterns and abnormalities in umbilical arterial blood gases, clinical cerebral function, neuroimaging studies, neonatal electroencephalography, placental pathology, hematologic studies, and multisystem organ dysfunction need to be considered in diagnosing an intrapartum hypoxic—ischemic event 5.
The Apgar score is not designed to predict the future health of the child. Arulkumaran S. Fetal surveillance in labor. Munro Kerr's Operative Obstetrics. Philadelphia, PA: Elsevier; chap 9. Goyal NK. The newborn infant. In: Kliegman RM, St. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier; chap Updated by: Neil K. Editorial team. Apgar score. Explore the characteristics and health of Finally your baby is here! Knowing what to expect in the first hours after baby is born can make it easier for you to start getting to know your newborn.
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You are welcome to continue browsing this site with this browser. Some features, tools or interaction may not work correctly. Perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth. At 5 minutes after birth, babies get the test again. If a baby's score was low at first and isn't better, or there are other concerns, the doctors and nurses will continue any needed medical care. They'll watch the baby closely.
Many babies with low scores are healthy and do just fine after getting used to life outside the womb. If your doctor or midwife is concerned about your baby's score, they'll let you know and will explain how your baby is doing, what might be causing problems if any , and what care is being given. This test helps health care providers tell a newborn's overall physical condition so they can quickly decide if a baby needs medical care right away.
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