Immediately after birth, the newborn receives its first rating - on the Apgar scale. It is based on a study by specialists of important indicators of a child - respiration, skin color, heart rate, assessment of muscle tone and reflexes of a newborn. The further actions of medical workers will depend on the results of this study. And it is precisely the Apgar assessment of the newborn that will help determine what should be the care of the child who was born, and whether he needs additional conditions. In addition, this study may indicate to specialists the likelihood of any pathology immediately after delivery.
What does the Apgar scale mean?
This study was proposed by the American anesthetist Virginia Apgar in the middle of the last century, namely in 1952. His initial task was for the mid-level medical staff to determine which babies need special care by evaluating the vital signs of the newborn.
This study also helps to find out how difficult the birth process was for the baby, how it affected him. Each of the main indicators can be affected by a difficult birth. For example, during childbirth, a child may experience hypoxia, i.e., a lack of oxygen as a result of being pulled with special forceps or having difficulty walking through the birth canal. As a result, skin integuments can change, which subsequently will affect the assessment of specialists on this scale.
Destination
From the above it follows that this study in extremely rare cases may indicate the possibility of the occurrence or presence of any pathology and pathological condition in a newborn child. In all other situations, an assessment of the main indicators of the baby who was born is necessary to understand how the birth affected the somatic state of the baby and what the baby's condition is right after the delivery process is completed.
It should be understood that in most cases this study is subjective. The final assessment can be influenced by many factors, the fundamental of which is the severity of the birth process.
A child who has average scores may have better health than a child who received the highest scores as a result of the study.
How are measurements taken?
The scale proposed by the American physician includes five indicators, the measurement of which occurs at the first and fifth minutes of the life of the newborn. Each criterion is rated from 0 to 2 points. Accordingly, the higher the indicator, the better the condition of the child at the time of birth. If the result of the study is less than 7 points, specialists continue to monitor the condition of the baby at 10 and 15 minutes of life.
If, as a result of the study, the state on the Apgar scale is rated low, the specialists will decide on the transfer of the newborn to a special department for placement in a special box and for additional medical care.
In the event that the child received low scores at birth, the specialist of the medical institution carries out resuscitation, so that the indicator obtained as a result of the secondary study increases significantly.
Indicators of the condition of the newborn
In total, five fundamental indicators of the state of a newborn baby are examined:
- the color of the skin of the baby;
- heart rate, i.e. pulse (heart rate);
- reaction to a stimulus;
- muscle tone and reflexes;
- breathing newborn.
Each criterion is evaluated from 0 to 2 points, and the Apgar scale itself is presented in the form of a table. When summarizing all five indicators, specialists of medical institutions receive a final result that allows you to assess the condition of the baby in the first minutes of life and to understand how well the child’s adaptation to the outside world proceeds.
Breath score
Normally, a newborn baby makes 40 to 45 respiratory movements per minute. It is this indicator that experts rate at two points. In addition, the baby screams, which also indicates the normal functioning of the lungs and also affects the result of the study. The doctor puts one point if the newborn cries, but does not scream, the voice trembles, and breathing is slow. If breathing and sounds are absent, the specialist puts zero points based on the study.
Heart Rate Assessment
The heart of a newborn baby beats very quickly. The birth process for both mom and baby is a lot of stress, which is why the baby needs time to adapt to environmental conditions. Normally, the heart rate of the baby that is born ranges from 130 to 140 beats per minute. With these indicators, the work of the heart of a newborn is estimated at two points. A specialist in a medical institution puts 1 point if the newborn breathes slowly enough and his heart rate is low. This phenomenon can occur if the child had a lack of oxygen in the womb or the supply of oxygen to the body of the crumbs was disturbed due to the severe course of delivery processes.
In the absence of a pulse, the child’s heart is evaluated at 0 points.
Assessment of muscle tone and reflexes
It is known that in the womb, the child does not have enough space by the end of the pregnancy, and the child’s position becomes monotonous. That is why the freedom of action gained by the newborn leads to the fact that the first movements of the baby, who was born, have a chaotic, erratic character. This is the norm. In this case, the doctor estimates the muscle tone indicator at two points.
If a newborn child holds the upper and lower limbs in a bent position and makes movements only occasionally, the specialist puts 1 point according to the results of a study of the state of muscle tone of the baby. If there are no movements, the doctor puts 0 points.
In addition, the doctor evaluates the presence of the main unconditioned reflexes of the child immediately after birth and their proper functioning. The presence of such is characterized by a scream and the first independent sigh. A medical professional monitors the reaction of a newborn to an irritant.
In the complete absence of unconditioned reflexes, experts evaluate this indicator at zero points. If external help was used to express them, the doctor puts one point on the results of a study of the newborn's reflexes. The baby gets the highest score in the event that unconditioned reflexes appeared without assistance.
How skin color is evaluated
Normally, the skin of the newborn has a color from pale pink to bright pink. It is this skin tone that indicates normal blood circulation in the baby's body. In addition, the specialist assesses the color of the mucous membranes of the child, lips, palms and soles of small crumbs legs. If the color of the skin of the baby is pink without additional shades, this indicator is estimated at two points. A child receives one point if his skin has a bluish tint. If such a shade has the whole body of the newborn baby completely or it is evenly white, the specialist puts zero points.
At birth, the color of the skin of the crumbs may have a bluish tint. After medical manipulations by a specialist, the baby's skin loses this feature. That is why the score obtained as a result of the secondary study is often higher than the original.
If the baby's skin retains a blue tint for a long time, this should alert the specialist and become a signal for additional studies.
Points on a scale
The optimal condition of the newborn is estimated at 7-10 points. A child's assessment on the Apgar scale of 5-6 points indicates the presence of mild abnormalities in the condition of the baby. 3-4 points characterize the average deviations in the somatic state of the crumbs. And, finally, 0-2 points signal that the condition of the child is far from normal, and he needs constant monitoring by specialists.
Decoding of the Apgar scale
To understand the results of the study, you need to find out what the Apgar score means. Assessment of the fundamental indicators of the condition of the newborn occurs two times: in the first and fifth minutes of life. That is why the second result may differ slightly from the original score. So, for example, at birth, the baby received 7 points, and after 5 minutes his condition was rated at 8 points on the Apgar scale. It is worth noting that the difference between the indicators may differ not by one but by several units, but may not change at all.
For example, at birth, the condition of the child required medical supervision as a result of a difficult birth (or under other conditions) and was assessed at 6 points on the Apgar scale, and after 5 minutes the newborn was slightly adapted, and the initial indicator increased to 8.
It should be understood that the data obtained as a result of examination of the newborn are not an estimate of the overall health of the child and in no case does not signal the mental pathologies of the baby. This study evaluates the condition of the baby at the time of birth and makes it possible to understand how well the newborn has had a birth.
The maximum score, 10 points, newborns get extremely rare. The most common results are 7-8 points.
What factors can affect scores
The result of the study may be affected by the severe course of the delivery process, as a result of which asphyxia was observed in the child. In addition, the cause of low rates may be hypoxia, which, in turn, can be chronic and acute. Chronic hypoxia accompanies the child throughout the entire period of pregnancy, it occurs due to malformations or pathologies of pregnancy. The acute form occurs during delivery.
In addition, a low Apgar score can be associated with many other factors - injuries and infections. So, for example, a mild form of brain damage in a newborn baby, a syndrome of increased neuro-reflex excitability, is evaluated at 7 points.
Instead of a conclusion
A study of the condition of a newborn baby, carried out in the first few minutes after his birth, allows the doctor to understand the need for additional medical care for a child who has just been born, and makes it possible to quickly respond in case of unforeseen situations.
It should be noted that points on the Apgar scale in no way characterize the overall health of the baby. Why then are these indicators needed? An Apgar score can only predict the occurrence of various pathologies. But it does not guarantee the appearance of those.
A low indicator, obtained as a result of a study of crumbs, should not cause mom to panic. The result can be affected by many factors, including the features of the course of labor.
Do not be upset if the baby received low marks as a result of the study. Indeed, in most cases it is subjective. Even the healthiest baby can not get the highest scores just for the reason that his limbs turn a little blue during childbirth or he screams out loud enough.
Wary should assess below 5-6 points. In other cases, nothing threatens the condition of the newborn baby.