Apgar assessment of newborns: explanation. First exam: Apgar score 7 at birth

The point system at school is a clear scheme for assessing knowledge according to certain criteria. If we talk about the Apgar score - a system for assessing the health of a newborn, then it is subjective. Compared to school, there is not a wide range of grades. The midwife does them by eye during examination.

In order for future mothers to understand exactly how the condition of their child will be assessed after childbirth, we will consider in detail the principle of this scale itself.

How the scale works

What is the Apgar scale and who is its founder? Virginia Apgar, a famous American professor of anesthesiology, introduced a scale for assessing the health of a newborn child back in the 50s of the last century. The main goal of her method was to promptly identify babies in need of resuscitation measures. Initially, the scale was intended for nursing staff. It was used to determine which child needed more attention.

The technique was named after its founder. Sixty years of experience in using such assessment of a newborn gives reason to believe that the Apgar scale is still quite simple and reliable for a comprehensive assessment. According to many experts, it is a little subjective, because points are given only on the basis of an obstetric examination of the child. The rating scale ranges from 0 to 2 points, where 0 is given for the absence of a certain feature, 1 is given for its average severity, 2 for a well-expressed feature.

Let's look at what exactly is assessed on the scale. It should be noted that for ease of assessment, the English transcription of Mrs. Virginia’s surname was taken. In the word APGAR, each letter stands for a specific evaluation parameter.

A - activity - activity and muscle tone of the child. A healthy baby has arms and legs pressed to the body, fists clenched. The child is active, moves, his face expresses emotions of peace or dissatisfaction with a cry.
P - pulse - pulse. The baby's heart rate is normally 130-140 beats per minute. If this indicator in a newborn is more than one hundred beats per minute, then it is given 2 points, less than one hundred - 1 point, and the absence of heart rate is recorded as 0 points.
G - grimace response - the child’s grimaces, the manifestation and degree of expression of the newborn’s unconditioned reflexes.
A - appearance - skin color and appearance of the child. Shades of pink (from bright to pale) are considered normal. The presence of blueness of the skin, called cyanosis, provides grounds for reducing the score.
R - respiration - the child’s cry, his breathing, reflex excitability. If a newborn screamed loudly and piercingly immediately after birth, then the score for this parameter is 2 points. A weak cry turning into a squeak, low breathing rate is assessed as 1 point. Lack of breathing and screaming - 0 points.

Assessment results and forecasts

The Apgar scale is used to assess the condition of a newborn twice: in the first and fifth minutes of his life. The first minute assessment shows how the baby experienced the birth. The second assessment indicates the degree of its adaptation to the environment.

Condition results are recorded as a fraction, where the first number represents the first assessment and the second number represents the assessment during the second measurement. It should be emphasized that this scale is not the basis for making further forecasts of the child’s condition and health.

Its results are interpreted as follows:

7-10 points - no deviations in health status were identified;
5-6 points - minor deviations;
3-4 points - significant deviations from the norm;
0-2 points - threat to the life of the newborn.

Children with the best results are considered to be in excellent condition and require only routine care. A score of up to 6 points indicates a satisfactory condition and the need for some resuscitation procedures. A child with a score of less than 4 points requires such procedures immediately. If the sum during the second measurement is less than 7, then additional measurements must be taken every 5 minutes. A child who receives 5-6 points on the first measurement and 7-10 on the second goes into the category of healthy children. It should be noted that an Apgar score of 10 is quite rare.

Let us remind you once again about the subjectivity of the Apgar scale and that it is not a method for predicting the development of a baby. Therefore, it cannot be said that a child with a 9-point score will be smarter or healthier than one who received 6 points. The development, health, and abilities of each child are directly proportional to the care, love, and attention of his parents.

Especially for Elena TOLOCHIK

Development by week

Breast-feeding

The Apgar scale is used by obstetricians and neonatologists to determine the condition of the newborn in the first minutes after birth. The results of such an examination are entered into the children's medical record and taken into account by pediatricians, as well as specialists, in the first year of the baby's life. For parents, the Apgar scale is often something incomprehensible. Let's look at what an Apgar score is and how to decipher the scores that are given to a newly born toddler.

Story

The assessment of all newborns was developed by American anesthesiologist Virginia Apgar more than 60 years ago, which is why the scale bears her name. The purpose of creating such an examination was to quickly assess the condition of babies immediately after birth. The method turned out to be very convenient and simple, which allowed it to enter obstetric practice. Today, the Apgar scale is used by thousands of doctors in different parts of the world.

Indicators

The Apgar scale evaluates the following criteria:

Child's skin color (Appearance). This indicator is very informative, simple and allows you to identify circulatory disorders. If the baby's body is completely pale or there is a bluish color over its entire surface, a score of 0 is given. Pale coloration is often detected in hemolytic disease. If the body is pink, but the arms and legs are blue, the child is given 1 point. If the skin of the toddler's body is completely pink, this is 2 points. Since most babies have red skin color, and cyanosis of the extremities is detected very often, this parameter most often underestimates the total Apgar score (children are rarely given 2 points).
Baby's heart rate (Pulse). The normal heart rate for newborns is 120-140 beats per minute. If there are no heartbeats, the score will be 0 points. If the pulse is less than 100 beats per minute, the baby is given 1 point. When the heart rate of a newborn is above 100 beats, a score of 2 is given.
The presence of reflexes and reactions to stimulation (Grimace). To determine them, mucus is sucked out of the baby’s nose and their reaction is observed or other reflexes are checked. The absence of reflex movements is scored 0 points, and for weak reflexes, represented by a grimace and movement, the baby is given 1 point. If the baby actively moves in response to irritation, screams loudly, sneezes, coughs, this is assessed as 2 points.
State of muscle tone (Activity). Normally, a newborn has increased muscle tone, and the baby actively moves its legs and arms chaotically. If there is no muscle tone and the baby’s limbs hang down, the parameter is scored 0 points. With weak tone and slight flexion of the limbs, the child is given 1 point, and activity and the presence of pronounced tone gives the right to give 2 points for this sign.
Breathing and crying of a child (Respiration). The age norm for the frequency of respiratory movements for a newly born baby is 40-45 per minute. If the baby screams loudly, this helps him breathe more intensely and is a sign of good adaptive capabilities of the toddler. If there is no breathing, the child receives 0 points. If the breathing is irregular and shallow, and the cry is weak, this is 1 point. With normal breathing and a loud cry, the child will have a score of 2 points. If a child has asphyxia, it is this parameter that lowers the Apgar score.

Decoding

As noted above, the doctor evaluates each of the indicators using a 3-point system: 0 – if the sign is absent, 1 – if it is weakly expressed, 2 – if everything is normal and the sign is clearly expressed. All points given are added up to form a total score.

The following table will help you decipher the amount of points for newborns:

0, 1 or 2 points	This is a critical indicator. A child with such an assessment at birth requires urgent resuscitation. In the future, it needs to be comprehensively examined and monitored by specialists.
3 or 4 points	This is a satisfactory indicator with average deviations from the norm. It is quite often determined in a premature baby. With such an assessment, the baby needs close attention from doctors.
5 or 6 points	This is a satisfactory indicator, in which there are slight deviations from the norm. A child with such an assessment also needs increased attention from doctors.
7, 8 or 9 points	This is the optimal value for the baby at birth. It pleases both doctors and new parents.
10 points	This is the best indicator (maximum score), which a healthy baby often receives abroad, but it is not used by domestic doctors because of our mentality. Doctors are afraid to set the maximum so as not to “jinx it” or believe that the ideal condition for most babies these days does not exist.

Examination algorithm

The baby is assessed twice - one test in the first minute of life, and then a second examination in the fifth minute. The sum of points is written down through a dash (like fractions), for example, 7/8 will mean that immediately after birth the baby had 7 points, and after 5 minutes it became 8 points. If the indicator is 0/4, then this means 0 points during childbirth and 4 points in the fifth minute after birth. If necessary, a third examination is performed at the tenth minute.

The most common Apgar score for healthy babies is 8. In such infants, normal values (2 points) for three parameters and a slight decrease (1 point) for two parameters are noted, for example, due to cyanosis of the extremities and a pulse below 100. Children are very rarely given the maximum 10 points.

In most cases, the second/third rating is higher than the first, which is characterized as positive dynamics. This is due to the newborn’s adaptation to new living conditions. The baby's pulse quickens, breathing normalizes, the skin turns pink, the protective reflex and other reactions become more active. However, there is also a reduction, for example, 9/8 or 8/7. In this case, medical monitoring of the baby is intensified.

What do the following points mean?

Let's look at examples of Apgar scores and their meanings:

8/9, 9/9 or 9/10	The baby is in very good condition and feels great. He does not require close supervision by obstetric staff after birth.
	The child is in normal condition, feels well and quickly adapts to life outside the mother’s womb.
5/7, 6/7 or 7/8	The baby's health is average. The baby is weakened immediately after birth, but adapts well to new conditions. The baby does not need close medical supervision from medical staff.
	The little one is in satisfactory condition. He does not need additional supervision from obstetric staff.
5/5 or 6/6	The baby's condition is satisfactory, but requires careful monitoring in the postpartum period.
4/5 or 5/6	The baby is in below average condition, but there is a tendency to improve. The baby should be closely monitored during the first week of life.
4/4 or 3/4	The child's condition is poor. He needs the help of obstetricians and more careful monitoring in the first weeks after birth. Typically, such assessments require a third examination at ten minutes of life.
2/3 or 3/3	The child is in critical condition. In most cases, he should undergo immediate resuscitation.
1/2 or 2/2	There is a threat to the baby's life, so resuscitation measures are required.
0.1, 0/2 or 1/1	The baby's life is at risk. Urgent resuscitation and a detailed examination of the baby are needed.

Forecast

When telling parents about the meaning of the Apgar scale, it should be noted that the sum of the points does not always show the real picture of the baby’s health. Do not forget that the points are given by a person (even though he is a health worker), based on his subjective opinion and experience.

Such an assessment also cannot be called a diagnosis. This is only an auxiliary method for pediatricians and obstetricians, with the help of which the baby’s viability is determined in a matter of seconds.

High Apgar numbers are not something to be proud of, and low ones should not be a cause for additional alarm. The main objective of this method is to help doctors provide timely assistance to the baby.

The difference between 4-5 points and 8-9 points is quite large, but if the baby received 7 or 8 points, this should not upset the mother, because a score of 9/9 does not mean that the baby is healthier and stronger than a baby with a score of 8/ 8 or 7/7. This may mean that a toddler with a score of 9 screamed more loudly and his reflexes were more pronounced, and a baby with a score of 8 could have a bluish discoloration of the skin due to prolonged labor.

Apgar numbers only act as a signal for obstetric staff, indicating what measures the baby needs in the delivery room and in the postpartum ward. After a general examination, all newborns undergo other examinations (blood test, urine test, ultrasound and other tests), as a result of which tactics for further medical support of the baby are determined.

In any case, an Apgar score below 5 means that the newborn requires the attention of medical staff much more than a baby with scores of 7 or higher. However, if in the first minute the baby received 4-5 points, and in the fifth his condition can be assessed as 7 or 8 points, then the baby is transferred to the category of children who do not require close medical supervision.

Note that Babies after cesarean often get higher Apgar scores, since the natural method of birth is more difficult for a baby and is often accompanied by hypoxia. For this reason, Caesars often receive grades of 8 and 9.

As for multiple pregnancies, Apgar scores are predominantly low in twins and twins. In most cases, such babies are born earlier, and premature babies have worse developmental indicators than babies born at term.

A low Apgar score is also given in case of birth injuries, for example, if it resulted in severe spastic tetraparesis. The consequences of such injuries vary, but it is difficult to say for sure that the child will be disabled in the first minutes after birth. Having given the baby low scores, the baby is given the necessary help and treatment is prescribed.

The Apgar score for newborns is a modern way of assessing the readiness of infants for extrauterine life. The first exam will not affect your love for your baby, but it won’t hurt to learn about the intricacies of passing it and the meaning of the mysterious numbers in the extract from the maternity hospital. Let's talk in more detail about what the Apgar scale is, how to decipher it and what to do if your baby gets low scores.

From this article you will learn

What does this scale mean?

A scale for assessing the health of a newborn based on external signs is necessary for obstetricians-gynecologists and pediatricians present at the birth. Based on the results of the examination and the summation of points, a decision is made on the mandatory provision of emergency resuscitation care to the baby and on the possibility of transferring him to the mother in labor in a shared ward.

The APGAR system was developed in 1952 as a teaching material for students and an aid in the work of nurses. The innovation was given the name of its creator - an anesthesiologist Virginia Apgar, professor. The invention of the rating was required by the increasing number of cases of births of children with intrauterine pathologies and strangulation during childbirth. And it has been successfully used in obstetrics and pediatrics for 70 years.

Apgar scale – score range from 0 to 10 points. The child is examined twice in the first and fifth minutes after birth, and scores are assigned according to 5 indicators:

epidermis color– A (Appearance);
heart rate– P (Pulse);
reflexes, reflex excitability– G (Grimace);
muscle tone, motor activity– A (Activity);
breathing pattern– R (Respiration).

For each item, the baby receives from 0 to 2 points. After summing up the points, the result on the Apgar scale is ready. If the result of the examination at the fifth minute is 0–7 points, then the assessment is carried out three more times after an equal period of time: at the 10–15–20th minute. Determining the result takes no more than one minute, no additional equipment is required.

In the postpartum discharge, the child has at least 2 indicators on the scale, for example 7/9 or other numbers. This will mean that in the first minute he received 7 points, and in the fifth - 9. To evaluate the result positively, it is important to see the dynamics of adaptation (the first numbers will be less than the subsequent ones).

Learn more about each option

The condition of the newborn is assessed based on external signs of the body’s vital functions. To understand how this happens, let’s look at each point in more detail.

Obstetricians and pediatricians use the table to quickly obtain results on the Apgar scale. She looks like this ( Attention! The table can be scrolled left and right):

Parameter	0 points	1 point	2 points
Color of the skin	Pale, blue (cyanosis).	The legs and arms are bluish, the rest of the body is pale pink.	The skin tone is even, pink over the entire surface of the body.
Heart rate	Single manifestations, no pulse.	Less than 100 beats per minute.	130–140 beats per minute.
Reflexes	Complete absence.	Lack of expression.	Pronounced swallowing, sucking, grasping.
Muscle tone	No movement.	Body movements are weak and rare.	Chaotically, regularly swings its limbs.
Breath	Absent.	Moans, breathes irregularly (hypoventilation).	Screams, breathes deeply, often.

The result of the assessment is the summation of points for each indicator. This happens as follows:

Color of the skin

If a newborn has a light pink or hot pink skin tone, it receives 2 points. A bluish tint of the extremities with a normal color of the epidermis of the rest of the body reduces the score to 1 point and signals the doctor about weak fetal hypoxia.

Everywhere the blue color of the skin, excessive pallor is a reason to carry out resuscitation procedures and give 0 points for the first indicator.

This is interesting! By the way, children born through cesarean section more often receive the maximum 2 points for this criterion. This is due to the fact that the natural passage of the birth canal is not easy for the baby and can affect the level of oxygen in the tissues. But the Caesars manage to avoid this.

Pulse

Heart rate is measured 6 seconds after birth by auscultation, palpation of the chest or palpation of the arteries. Then they multiply the resulting figure by 10, which gives the minute result.

The heart of newborns works actively. The norm is considered to be a pulse in the range from 130 to 140 beats per minute. In this case, the child earns 2 points.

If the heart beats unstably and slowly, the baby receives 1 point; if there is no pulse at all, 0 points.

If the indicators are not normal, then the baby is given resuscitation procedures until the heart rate returns to normal.

Reflexes

The ability to suck, grab, swallow, and breathe are the first reflexes of newborns necessary for life. If the child clearly shows the presence of these innate skills in the first minutes of life, then he receives a high score of 2 points. The baby should look for the breast, smack his lips, scream after birth, and breathe.

If reflexes are weakly or partially expressed, then he earns 1 point, if they are completely absent - 0 points.

To obtain an objective assessment, obstetricians stimulate manifestations of reflex movements:

put a finger to the baby’s lips;
place the newborn on a flat surface, encouraging him to step;
lay on the tummy and push under the heels, awakening the crawling reflex;
a catheter is inserted to clear mucus from the baby’s nose; It’s great if the baby sneezes, grimaces, and moves his head away.
Muscle tone

Chaotic movements of the arms and legs are the main indicator of the baby’s well-being immediately after birth. He strives to straighten his limbs and bring his body to its normal position. This behavior adds 2 points to the total.

The baby gets 1 point if:

moves weakly, but does it reluctantly;
arms and legs remain in a bent position.

With a complete absence of body movements, maintaining the fetal position or close to it - 0 points.

Breath

The baby earns 2 points if he screams piercingly after birth and in the first minute of life maintains a normal breathing rhythm - 40-45 inhalations and exhalations. If, instead of screaming, the newborn moans, wheezes, or breathes unevenly, he will be given 1 point; if there are no manifestations of this criterion, he will be given 0 points.

Important! It is worth considering that premature babies born unnaturally, but through cesarean section, receive lower Apgar test results. Women should not be upset about this and invent shortcomings for the baby. Attention, care and careful care can quickly correct the situation.

What do ratings mean?

In the delivery room, women are usually not given accurate Apgar scores. Parents see the result in the card after discharge home or find out from the doctor. To decipher the results yourself, use the following decoding of the sum of points.

0-2 . The newborn is in a critical situation and requires the help of a resuscitator.
3-4 . The indicator is satisfactory. Deviations from the norm are average. Premature babies often get this result. After birth, the baby is observed by a pediatrician, obstetrician, and neurologist.
5-6 . Satisfactory result, deviations from the norm are small.
7-9 . The indicators are optimally positive. Deviations are weak.
10 . Healthy child.

To simplify the algorithm for evaluating the results, we give examples of the results of testing of newborns:

8/9, 9/9, 9/10

The baby feels wonderful. Doctors and mother do not need to worry about his well-being and closely monitor his condition until discharge from the hospital.

The clinical result is normal. The baby feels good and has adapted to the external environment quickly.

7/8, 6/7, 5/7

Perhaps the baby was born a little weakened, but quickly recovered by the fifth minute. She feels well and does not require medical care or close supervision by a pediatrician.

Satisfactory indicator. Urgent medical attention is not needed.

6/6, 5/5

The condition is average; pediatricians need to monitor the newborn more closely.

4/5, 5/6

The result is below average, but there is a positive trend. The child is observed more closely for 1–2 weeks after discharge.

4/4, 3/4

This result requires measurement at the tenth minute after birth. The baby's physical condition is poor. In this case, the woman and child are placed in a hospital for further observations.

2/3, 3/3

Resuscitation is needed, the condition is critical.

2/2, 1/2

The child shows obvious signs of asphyxia, and there is a threat to the life of the newborn. Pediatricians must provide immediate resuscitation.

0/2, 0/1, 1/1

The situation is difficult, the baby is on the verge of life and death. It is impossible to do without resuscitation and a detailed examination.

This is interesting! A score of 10 is given to newborns in Russia extremely rarely. This is due to the mentality of the medical staff, the fear of jinxing things and showing unprofessionalism. Thus, 9 points can correspond to 10, accepted internationally.

What is considered normal

Newborn Apgar assessment is a worldwide method for detecting defects in intrauterine development of infants. In obstetrics, he was loved for his objectivity and simplicity. The sum of points allows you to get a complete clinical picture of the baby’s condition, draw up a plan for observation and postpartum care for him.

Glasses are considered normal indicators of the level of physical and reflex development from 7 to 10. In this case, the baby does not require medical care; it is handed over to the mother in labor and applied to the breast.

5–6 - slight deviations;

Rehabilitation takes time; often the deficiencies are temporary. Associated with asphyxia and fetal immaturity.

3–4 - general condition is unsatisfactory;

There is an average degree of oxygen starvation of the baby. Resuscitation procedures will be required to bring breathing and pulse to a normal rhythm.

0–2 - critical situation;

There is a risk of death of the newborn. First of all, respiratory stimulation (ventilation) is carried out. The reason for low indicators may be low body weight of the baby, prematurity, hypoxia.

The level of manifestation of the Apgar scale criteria is determined twice: in the first and fifth minutes. When indicators are low, it is important to observe positive dynamics. If a child received 4–5 points in the first minute, but 7–9 in the fifth, then he is considered a healthy child. The lack of dynamics is an alarming sign, a reason to take measurements two or three more times and provide the baby with urgent resuscitation care.

It is important to understand that the Apgar test is subjective for the further development of the baby. Kids with a score of 9–7 will not necessarily be smarter or stronger than those who received low scores.

What if the score is low

Early diagnosis of a newborn’s condition is a lifesaver for modern obstetricians. The Apgar rating indicates the level of well-being of the baby in the first minutes of life. Of course, all parents hope for the birth of a healthy, strong baby, which means high marks on the scale.

Low scores indicate the presence of congenital developmental anomalies and poor adaptation of the infant to the external environment. The most common reasons for negative results are:

Asphyxia – suffocation. Occurs as a result of entanglement of the fetus with the umbilical cord, obstruction of the respiratory tract with mucus and amniotic fluid.
Hypoxia is a lack of oxygen during the prenatal period. The brain and tissues do not receive enough oxygen. This results in bluish skin, swelling, and low physical activity in the first minute of life.
Prematurity. Physiological immaturity, insufficient body weight.
Birth injury. A healthy fetus suffers during the passage of the birth canal.
Intrauterine infections. Transmitted from mother to fetus.
Incompatibility of blood between mother and fetus. Risk of Rhesus conflict.

Asphyxia and hypoxia are considered especially dangerous. Prolonged lack of oxygen leads to serious developmental problems in the child in the future and provokes serious neurological diseases, such as:

Syndrome of increased reflex and nervous excitability. It persists in children up to 3 months of age. Babies are restless, often cry, and sleep poorly. Decreased or increased muscle tone, trembling of the chin and limbs are recorded.
Convulsive syndrome. Leads to epilepsy. Characterized by involuntary contraction of one or a group of muscles.
Comatose syndrome. Consciousness, sensitivity, and motor function are depressed.
CNS depression. Reflexes are weak, the baby sleeps a lot and eats little.
Hydrocephalus. Fluid accumulates in the newborn's brain. A delay in physical and mental development is diagnosed.

Birth trauma causes cerebral palsy, VSD, hypertension, and motor impairment. The consequences of intrauterine infection are difficult to predict. These are various diseases of hearing, vision, internal organs, and stillbirth.

Babies with hypoxia or asphyxia are born weak and passive. The Apgar test result is measured two to four times and is no more than 6 points. By organizing proper care, providing professional medical care, and following pediatricians’ recommendations, normalization of the baby’s condition is possible. And the quality of life of the child and parents will depend on this.

Important! Low Apgar test results in premature babies are similar to average in those born on time unless there is serious cause for concern. For example, 6/7 in immature infants is the norm. But regular observations by a neurologist and other specialized specialists will still be required.

Don't be discouraged if your child's Apgar scores are lower than the maximum. After all, everything that is most important for his development will be laid down further - in the first years of life. And a lot will depend on your love and desire to raise your child healthy and happy.

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Apgar, who invented Apgar

What is the Apgar score? This is a simple, internationally recognized way to quickly assess the condition of a newborn in order to understand how much the baby needs emergency care and, if there are several newborns, which is not uncommon in large maternity homes, who to give priority attention to.

She proposed this useful tool at the 27th Congress of Anesthesiologists in 1952 doctor Virginia Apgar. It must be said that Virginia herself was a professional of the highest class, moreover, she became a highly qualified doctor at a time when medicine in the United States was exclusively “male territory.” So the respected anesthesiologist, who worked in obstetrics for a long time, did not even think of adding her name to the annals of history. However, 11 years later, Hungarian pediatrician Joseph Butterfield came up with a convenient mnemonic rule, linking one of the criteria for assessing the condition of a newborn to each letter of the Apgar surname.

A ppearance - appearance (skin color);

P ulse (Heart Rate) - child’s pulse (heart rate);

G rimace (Response to Stimulation) - a grimace that occurs in response to irritation;

A ctivity (Muscle Tone) - activity of movements, muscle tone;

R espiration - breathing movements.

Virginia's surname turned out to be a successful acronym for other European languages. In German it is A tmung, P uls, G runtonus, A ussehen, R eflexe, in Spanish - A pariencia P ulso, G esticulación, A ctividad, R espiración. There is no good mnemonic rule in Russian, so our obstetricians had to memorize the five criteria without any prompting.

What is assessed by the Apgar score?

So, the five indicators that Virginia Apgar identified are: breathing, muscle tone, reflexes, heartbeat and skin color. For each indicator, a score from 0 to 2 is assigned.

If breath If the baby has a frequency of 40-50 sighs and exits per minute, and the cry at birth is loud and shrill, then such readings are considered at the level of two points. Weaker readings are recorded with 1 point. If there is no breathing, and therefore no cry in the newborn, doctors set the score to 0 points.

Muscle tone determined by the child’s position in space, active chaotic movements of all limbs and head.

A newborn baby simply needs vital reflexes associated with his further full life, namely: swallowing and sucking reflex. In the first minutes of life, the child can already reproduce elementary reflexes for sucking and swallowing breast milk, as well as reflexes for crawling and walking. If these reflexes are actively manifested in a child, the child receives the maximum score, and if these reflexes are more sluggish or not all expressed, then the child receives a score of 1 point. The absence of any reflexes in a child is assessed as 0 points.

If heart rate child exceeds one hundred beats per minute, then it is assessed at the maximum score (2). If the baby's heartbeat is below one hundred beats per minute, it is scored 1 point. And if there is no pulse at all, then the score is set to 0 points.

Deserves the highest score in this assessment baby's skin is pink or slightly bright in color, the skin is usually smooth without bruises and blue spots. If the skin is pale pink with a possible slight blue tint, then the Apgar score is set to 1 point. Too pale skin and visual absence of vital signs are scored 0 points.

Apgar table

	2 points	1 point	0 points
Breath	40-45 breaths per minute, clear, loud cry	Breathing is irregular, cry is weak	There is no breathing
Muscle tone	Expressed, active movements	Limbs bent	No movement
Reflexes	Reaction in the form of coughing, sneezing, loud screaming	Grimace, movements	No reflexes
Heartbeat	More than 120 beats per minute	Less than 120 beats per minute	Absent
Color of the skin	Red, pink	Blue limbs	Pale

Scoring is usually carried out in the first and fifth minutes of life, so there are always two Apgar scores, for example 8/9 points. For obstetricians and neonatologists, not only absolute indicators are important, but also the change in assessment - how much the child’s condition has improved in the first minutes of life.After all, the initial low score on this scale may be associated with a simultaneous situation at birth (acute hypoxia or asphyxia), or a chronic condition of the fetus (chronic hypoxia), or physiological immaturity.

What do Apgar scores mean?

Apgar score assessment This only gives doctors an idea of how the baby feels right away . They make no further assumptions about the child's development, since they are practically independent of the initial score. But they know exactly what actions to take immediately.

The condition of children who score from 7 to 10 points, are considered good or excellent and usually require routine care;

those who dialed from 4 to 6 points, are in satisfactory condition and may require only some resuscitation procedures;

those whose result below 4, required immediate assistance to save their lives.

The most common cause of a low Apgar score is hypoxia, a pathological condition associated with oxygen deficiency in the child during pregnancy and childbirth.

It should be remembered that Apgar score - subjective. Therefore, it cannot be said unequivocally that a child who received 10 points on the Apgar scale is healthier than a child who received 7 points. This only means that in the first case the newborn breathes normally, his skin and mucous membranes are pink, he screams quite loudly, and his reflexes are well expressed. And in the second case, one or two signs were less pronounced, he could not scream too loudly, or cyanosis was noted - blueness of the skin.

Modern parents, after the birth of a long-awaited miracle, are often faced with such a concept as the “Apgar scale.” After birth, the primary responsibility of the physician is to assign a score to the baby based on this scale. Together with the child’s height and weight, these indicators are entered into the general chart; rather, they are required more for doctors than for the baby’s mother. However, let's consider what it is apgar scale for newborns in the table, how and where it found application.

Conducting a health assessment

Based on the rating scale, it is carried out on the basis of awarding points to each child. Their maximum number is 10. Almost no one is given it, although such tiny ones have also been encountered. Don't panic if your baby's score is even lower than 9. If the baby cried at birth and began to breathe on his own, he was given to you to feed, this indicates his viability. But this does not at all mean that he is 100% healthy, so even certain tests must be carried out.

Assessment of the newborn's condition using the Apgar scale carried out in all cases, regardless of the wishes of the baby’s mother. The mother’s permission is usually asked for vaccination, but it is not required for a health check. To carry out the analysis, blood is taken from the baby's toe, and it is checked for the most common mutations. If they are detected, proper treatment is traditionally prescribed, as a result of which the child grows and develops healthy. Fortunately, such pathologies are rare in children, occurring in approximately 1% of children.

Immediately from the moment the baby is born, a specialist checks for the presence of unconditional type reflexes. In principle, the mother will be able to carry out these activities, immediately leaving the maternity hospital.

Automatic gait. It is necessary to take the child by the armpits and turn his legs onto the table.
Crawling: if a child lying on his tummy is supported by his legs, he will begin to push off, this indicates that the reflex is working.

Apgar assessment of newborns, table shows the main criteria taken into account.

Giving an overall score

The condition is analyzed promptly by doctors, and the result is given in the first five minutes. Experts pay attention to when the baby first screamed. The child’s skin color is also assessed and the reaction to the bright color of a flashlight is checked. The general muscle tone is determined and the heartbeat is observed.

The highest score - 10 or 9 - is given when the skin color is natural for a person. In this case, the baby must actively resist the fact that someone bends and unbends his limbs. There are several other requirements that must be met to receive a high score. So, the baby should avoid bright light, and when directing the light bulb, wrinkle his eyes and forehead.

The inaccuracy of the results may also be caused by the fact that not every child who has just been born can demonstrate optimal results. So, if newborn Apgar score 8-8 and more, this speaks about the standard indicators of his health. In addition, the temperament of the newly born person is also taken into account. After all, among mothers you can also find lazy individuals who love to lie on the sofa, so does it make sense to believe that the child will immediately become active?

It often happens that the first indicator is one point lower than the second. For example, you may encounter a situation where Apgar scale for newborns in the table is 7-8 points. The fact is that such an assessment is carried out at the 1st and 5th minutes of labor, so it is quite natural that there is a difference between the indicators. The child gradually becomes accustomed to a world that is completely new to him, and the rate increases. Traditionally, an improvement in the indicator occurs because the body is saturated with oxygen and the heart begins to work better.

Main features and criteria

To understand the doctors who diagnose, it is worth understanding certain parameters of the presented table.

	2 points	1 point	0 points
Muscle tone	The movement is active	The newborn is not active	No signs of movement
Work of breathing	Makes loud screams	The child screams quietly	The baby is not breathing and does not cry
Pulse	Normally – more than 100	Less than 100	No pulse
Skin color indicator	Soft pink color	Blueness in the extremities	bluish tint
Excitability of reflexes	Coughs and screams and is not happy with external stimuli	Poor movement and undeveloped reaction to external stimuli	Does not pay any attention to the presence of external stimuli

Based on the data presented in this scale, it can be carried out apgar test for newborns only for physical health. The analysis does not provide any data on the psychological and mental state.

What result will the baby get?

Newborn Apgar score 8-8 is considered normal, but not all babies can count on it. In this regard, every mother is concerned about the question of what grade the specialist will give her baby. We can say that this factor largely depends on her personal behavior. To make it work newborn Apgar score 9-9, it is necessary, after receiving good news about pregnancy, to immediately reconsider your diet, change your daily routine and strictly follow the specialist’s instructions. For such behavior after the birth of the long-awaited baby, you will be rewarded more than once, and Apgar scale for newborns in table 8-9- a completely natural result.

Do not neglect the general recommendations of doctors during childbirth. His physical health largely depends on the correct passage of the baby through the birth canal, so the mother’s task is to listen to the instructions and follow them. If you do not follow doctors' instructions, the baby may be born with blue skin. Of course, this will pass in the near future, but the assessment will have smaller numbers. Thus, if newborn Apgar scale 8-8, this indicates its normal development and the absence of actual problems with adaptation to external conditions.

What else does the assessment depend on?

Apgar chart for newborns is generalized, however, there are individual factors that can have a negative impact on the baby’s development. If the mother smokes during pregnancy or drinks alcohol, and also eats poorly and ignores the doctor’s instructions, therefore - condition of the newborn on the Apgar scale it will get much worse.

Don’t worry if any of the indicators are significantly lower than normal; this is not evidence that the child will get sick often or become disabled. Assessment of the newborn's condition using the Apgar and Silverman scales is important, but these data, as a rule, do not have any impact on the child’s future.

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