Apgar Test: How To Do It, Post-Care And Measurements

For any mother like you, the early arrival of a baby to shelter him in your arms can generate a little anxiety, since you understand that beyond pampering your baby after delivery, the most fundamental thing from conception is that it has good health. It is necessary to understand that at the time your baby will be born, it will have to go through some tests that allow doctors to know in what conditions its pulse is, its condition, its heart, its color, its skin, among others. The first test that your baby is subjected to at birth is called the Apgar Test, which is performed in the first and fifth minutes after the baby is born.

In this way, in front of the fixed gaze of the parents, the nurses and doctors will carry out a detailed evaluation of the baby, where certain evaluations are considered in order to rule out the probable need for extra care, in the face of an unexpected health-related problem of the baby. Know what the apgar test means, when it is performed, how it is done, history of the apgar test, parameters, its importance, among others. Being adequately informed of all the necessary tests from the moment your baby is born is essential to act appropriately and effectively for its good development and health.

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What is the apgar test?

It is an initial assessment that is carried out when your baby has been born, with the purpose of discovering probable complications quickly, which does not cause major discomfort to the baby. This assessment is carried out quickly, because if there is any complication it is vital to act immediately; If everything is normal, the time of the exam will not make your baby feel any discomfort.

The Apgar test owes its name to a doctor of American origin named Virginia Apgar, who specialized in anesthesia and pediatrics. The method was developed by Virginia Apgar in 1953, in that year the method was published to rapidly study the conditions of the newborn. Thanks to this test, many babies’ lives have been saved, by detecting any complication prematurely, which by not being detected in time can cause a fatal event in a few minutes.

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History of the apgar test

Virginia Apgar beyond being a pioneer in neonatology, teratology and anesthesiology. She became a perfect teacher, leader and thanks to her great personality she left a huge mark in the fields where she developed. Its name is directly related to the apgar test, a method that has been used to analyze the health of babies at birth and thanks to this method it has been possible to considerably reduce the infant mortality rate around the world.

In the 30s during the 20th century, sexism reigned, the vocation of surgeon led Virginia Apgar to anesthesiology, in this discipline she became one of the forerunners. In addition to setting the pedestals of perinatal medicine, improving the care of the baby at birth, along with the analysis of congenital anomalies. The famous apgar test grew out of his determination that children would not stop breathing in his operating room.For this reason, he dedicated himself to developing a quick and easy method that would allow a viable evaluation of the newborn. The apgar test was published for the first time in the journal Current Reasearches in Anesthesia and Analgesia. The simplicity and elegance of the study enhance the admiration of those who enjoy reading, then the apgar test was used in most maternity wards. Although Virginia Apgar died in the year 1974, today in any maternity hospital around the world she continues to give her eyes to all newborns. This simple method is the first that a pediatric resident learns when starting labor in the delivery room.

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Dr. Virginia Apgar noticed that many of the newborns died from anoxia (lack of oxygen), detecting three situations that caused anoxia: little training of the doctor who attended the baby, anesthesia of the mother which ended up sedating the newborn and the lack of approval about what is really normal in a newborn. At that time, being able to know the status of the fetus before birth was very complicated, since fetal monitors did not exist, but complications at birth cannot be denied by clinical examination. This was of great interest to Dr. Apgar, finding that the residents of her hospital began to carry out mandatory rotations in the obstetric area. Proper CPR techniques were applied to pale children, who were not breathing,

An anesthesiology resident once asked Dr. Apgar about the best and fastest way to assess the newborn. Apgar simply took a pencil and paper and replied: It is very simple, you only need to assess the following parameters: respiration, heart rate, activity or muscle tone, color and the response reflex to stimulation. At this time the Apgar test was born, for a year the doctor was creating a scoring system with which she could establish the paucity of applying CPR maneuvers, create a basis for discussion and comparison of obstetric processes, resuscitation results and the types of maternal anesthesia .

The analyzes carried out by colleagues and Apgar were used as a basis to fully understand the physiology of the baby and other aspects related to the metabolism of the mother and the fetus, which were unknown at the time.

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How to do an apgar test?

This test that studies the state of the baby at birth, which represents an excellent support to quickly reveal problems that the newborn may have. Thanks to the apgar test, it has been possible to reduce infant mortality and the rate of diseases, because the test regulates the health of the newborn in the crucial minutes and if necessary, special care is carried out on time.

In the apgar test, 5 parameters are measured and a score is provided according to the state of the newborn: between 0-1 and 2, with a maximum score of 10. When a newborn has a score that exceeds 7 points, it is considered a normal baby. If the score is between 4 and 6 points, it is considered as mildly depressed, that is, the newborn may require resuscitation. A score below 4 means that the newborn is severely depressed, so it urgently requires special care.

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Parameters

The parameters evaluated in the apgar test are: heart rate, reflexes, skin color and muscle tone; providing a score for each parameter of 0, 1 or 2 points (depends on the strength of the baby). In this way, by adding the ratings given to each of the parameters, a specific score will be given to the newborn. The lowest score is “0” and the highest is “10”.

HEART RATE

Through the stethoscope the heart rate is evaluated, this represents one of the main parameters . The newborn’s score will be 0 if there is no heartbeat. In the case of having a heart rate less than 100 beats in a minute, the score will be 1. But if the heart rate exceeds 100 beats per minute, in heart rate the score will be 2.

RESPIRATORY EFFORT

The score will be equal to 0 if the newborn is not breathing. The respiratory score will be 2, if the newborn cries well. When the breaths are irregular or slow, the newborn will have 1 point in respiratory effort.

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REFLECTION

The irritability or grimacing reflex (response to gestures) describes the response to stimulation as a slight pinch. In the irritability reflex, the newborn’s score will be 0, if there is no reaction. If there are grimaces or gesticulations in reflex of irritability, the score will be 1. If there is coughing and gesticulations, vigorous crying or sneezing, the newborn’s score in reflex of irritability is 2.

MUSCLE TONE

The newborn’s score is 0 for muscle tone if the muscles are flabby and loose. When there is some muscle tone, the baby’s score is 1. When there is active movement of the newborn in muscle tone, it is 2 points for the baby.

SKIN COLOR

The baby’s skin color score is 0, if the color is pale blue. The e-score of 2, if the baby has all pink skin. If the baby’s limbs are blue and the body is pink, it is 1 point in skin color.

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goals

The foundations of current neonatology were established by the Apgar test, in addition to reducing mortality in neonates. The objective of this method, according to Dr. Virginia Apgar’s own words, was to make a clear and simple classification of the newborn’s conditions, to facilitate comparisons of the results of the different obstetric skills, of the resuscitation of the baby and of analgesic guidelines .

Levels and values

Each parameter receives a score depending on the state of the newborn, as we were able to observe it in the previous items. As for the values, these can be normal or abnormal.

NORMAL VALUES

The higher the newborn baby’s score, the better his progress will be . In the apgar test your index is based on a total score between 1 and 10. Scores of 9, 8 and 7 are considered normal; indicating that the baby is in good health. A score of 10 is unusual, because practically all babies after birth due to bluish hands and feet lose a point, something common after birth.

ABNORMAL VALUES

Scores less than 7 indicate that the newborn requires medical care. The baby will need more help the lower the score, so that the process of adaptation to the external world is effective. Low scores can have different causes: cesarean section, difficult delivery or aspiration of amniotic fluid from the baby. The treatment applied in a low apgar score is by physical stimulation to get the heart beat in a healthy way and oxygen.

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HOW CAN I UNDERSTAND THE APGAR TEST SCORE?

When talking about scores, it may be a bit difficult to understand the test. We will try to make you understand it with simpler words: the final score of the apgar test can be between 1 point and 10 points. If your newborn’s score is higher, his evolution and adaptation will be better at birth. Even the most common is that the baby has a score between 7 and 9 since in general, many newborns lose a point due to bluish coloration in the feet or hands, something very normal at birth.

Conversely, if the score is low enough, your baby’s health is more serious and he will need more medical attention to adapt and survive outside the womb. These types of low scores are usually related to a cesarean section, complicated delivery, or amniotic fluid in the newborn’s airways. In most cases, it is enough to clean the baby’s airways and receive physical stimulation so that his heart can function properly.

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What is the interpretation?

Fortunately 90% of newborns have a normal score. Another factor that must necessarily be considered is how difficult and extensive the delivery is. Many times, when evaluating at the minute of birth, the points are low because the newborn is exhausted and the ventilation mechanics are difficult for him . For this reason, the test is performed at the minute of birth and not at the time of birth, because the interpretation would be altered due to delivery . After 5 minutes it is repeated, when the trauma of birth has been overcome.

THE APGAR TEST IS NOT A DIAGNOSIS OF ANY DISEASE

You should know that the apgar test was not developed as an index on the health of the newborn, nor as a method to diagnose a specific disease. A baby with a score of 8 is no less healthy than another with a score of 9. Dr. Apgar’s goal was to create a very simple index that will help doctors and nurses to give the best care to the newborn as well as helping to quickly decide if the baby would need more attention or resuscitation techniques.

DISAGREEMENT OF SCORES BETWEEN VARIOUS TESTS

In some cases, the apgar test generates a fairly low result, but at 5 minutes it gives a high score because not all babies have the same facility to adapt to the outside. A low score is a sign that something has happened to the baby: either he or she has a neuromuscular disease, is immature, or has received some of the anesthesia used on the mother; but the doctor does not know at this time whether the event is transitory or transcendent and originated from the baby’s physiology.

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Forecasts

The Apgar test, in general terms, does not by itself predict the future health of your baby. A slightly increased risk of cerebral palsy in newborns has been linked to a low 5-minute test score, but the vast majority of infants with a low 5-minute apgar score do not show cerebral palsy.

The apgar test score simply studies the well-being and health of a newborn , under no circumstances does it allow predicting the baby’s ability to have an excellent academic performance in the future.

The apgar test vs the Silverman and Anderson scale

Using the Silverman and Anderson scale, the respiratory distress of a baby is estimated at birth through the study of 5 clinical quantifications. Each parameter is assigned a value of 0-1 or 2 to have a total score, then the partial scores of the evaluation are added, to finally have the total points that will verify the level of the respiratory problem.

On the Silverman and Anderson scale, the score is opposite to that of the apgar test, the high score does not have a good prognosis and the low score has a better prognosis. Lack of respiratory distress (ideal score is 0), but severe respiratory distress has a score of 10.

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Nursing care after an apgar test

After the apgar test has been performed on the newborn, nursing care is common in all babies: the head circumference is measured and weighed (although in some centers this is delayed in humanized deliveries, so as not to interfere with the skin contact between the newborn and its mother). In addition, a purification of vitamin K is placed, it is an excellent way to avoid any bleeding problem in the baby. Eye drops are applied to the newborn’s eyes to block any ocular gonococcal infection. Cleaning in the first hours of your baby’s life is only superficial, without interfering with humanized contact.

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Apgar test in Down syndrome

The apgar test is quite useful to quickly assess the newborn, regardless of whether it comes with Down syndrome. But specifically in the baby with Down syndrome due to frequent hypotonia the score may be lower, there is even the probability of prematurity, but this should not be a concern for you. The Apgar test is a necessary assessment for the doctor, because he can know the appropriate way in which to proceed in case he requires immediate medical assistance. When a baby is born, it normally has a score between 7 and 10 in this test, but a child with Down syndrome has its results between 5 and 7 points, this does not mean that there is no possibility of having high scores.

At present, we know that children with this syndrome have their own characteristics that identify it from birth: oblique eyes, flat area behind, Brushfield spots, tiny ears and slightly bent in the upper area, small and sunken nose, tiny mouth , small hands, short neck and short fingers. Compared to a normal baby, the muscle tone of a baby with Down syndrome is lower, skull sutures separated more than normal, and excess skin at the nape.

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Additionally, some related complications are added: congenital anomalies in the heart, vision problems, profuse and early vomiting (can be related to duodenal atresia and esophageal atresia), chronic problems of constipation, hearing problems, sleep apnea and hypothyroidism, risk of hip dislocation and other problems.

The reflexes in a normal newborn collaborate in later development and survival, the Moro reflex is one of them, which may not be present or be very fragile in babies with Down syndrome, delaying postural development.

What is the family apgar test?

Dr. Gabriel Smilkstein in 1978, created an instrument where the functional status of all family members could be studied through family perception. He named it the family apgar test in honor of the apgar test. In this way, I found that his family test would be quick to remember, he also managed to develop an acronym indicating the most important functions of the family: adaptation, participation gradient of personal resources, affection and resources. This test is carried out as a questionnaire that includes 5 questions, currently the apgar family test has several adaptations. In this questionnaire, the family member indicates the form or degree in which they perceive these functions in their family nucleus. The score is between 0 and 4,

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What is the importance of the apgar test?

For doctors, the apgar test constitutes the first evaluation of the newborn, through this evaluation instrument, doctors can determine the appropriate immediate medical attention so that the newborn can stabilize. The evaluation in the first minute of life of the newborn is fundamental, since it is a definitive factor for the neurological prognosis of the child. Especially if the baby at 5 minutes has not had a score greater than 7, the test continues to be practiced every 5 minutes until the newborn has healed.

All newborns by convention are assigned the apgar score, although this practice is essential in babies who were asphyxiated at birth. Currently in the delivery room, active resuscitation, specific neurological evaluations, measurement of other metabolic parameters in the blood and other novel measures such as hemodynamic and ventilatory support, selective hypothermia; They have reduced a bit of prominence to the apgar test when making decisions.

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What are the measures taken when faced with a low Apgar test?

When there is a low score, the measures taken in the Apgar test depend mainly on the adequate way to establish the cause. One of the most common causes is respiratory, the newborn’s secretions are aspirated and oxygen is applied if necessary, in this way the baby can have an adequate saturation.

Physical stimulation is also very common, to help the baby’s heart rate increase and reflexes develop. Finally, if the low score indicates the placement of medication and fluids, the administration will be done through a canalized umbilical cord route.

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Kathie Sand always saw the world of beauty as the terrain on which to build her professional career, a goal that was clear to her when she was only 15 years old. Her great concern to expand knowledge led her to settle in Paris where she studied hand in hand with the best beauty professionals and with the most advanced techniques for skin care.

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