The Apgar Score

The Apgar Score ABSTRACT: The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. Introduction In 1952, Dr. Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing (1). A second report evaluating a larger number of patients was published in 1958 (2). This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises five components: 1) color, 2) heart rate, 3) reflexes, 4) muscle tone, and 5) respiration, each of which is given a score of 0, 1, or 2. Thus, the Apgar score quantitates clinical signs of neonatal depression such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasp- ing respirations. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7 (3). The Apgar score provides an accepted and convenient method for reporting the sta- tus of the newborn infant immediately after birth and the response to resuscitation if needed; however, it has been inappropriately used to predict individual adverse neurologic outcome. The purpose of this statement is to place the Apgar score in its proper perspective. This statement revises the 2006 College Committee Opinion and AAP Policy Statement to include updated guidance from Neonatal Encephalopathy and Neurologic Outcome, Second Edition, along with new guidance on neonatal resuscitation. The Neonatal Resuscitation Program guidelines state that the Apgar score is useful for conveying information about the newborn’s overall status and response to resus- citation. However, resuscitation must be initi- ated before the 1-minute score is assigned. Therefore, the Apgar score is not used to deter- mine the need for initial resuscitation, what resuscitation steps are necessary, or when to use them (3). An Apgar score that remains 0 beyond 10 minutes of age may, however, be useful in determining whether contin- ued 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 (3–5). In line with this, the 2011 Neonatal Resuscitation Program guidelines state that “if you can confirm that no heart rate has been detectable for at least 10 minutes, discontinuation of resuscitative efforts may be appro- priate” (3). COMMITTEE OPINION Number 644 • October 2015 (Replaces Committee Opinion Number 333, May 2006) (Reaffirmed 2017) Committee on Obstetric Practice American Academy of Pediatrics—Committee on Fetus and Newborn This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. This document reflects emerging concepts on patient safety and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS.

[Audio] The American College of Obstetricians and Gynecologists recommends using an expanded Apgar score reporting form because it considers resuscitative interventions when calculating the score. This approach acknowledges that resuscitative interventions can change the factors contributing to the score. An assisted score that accounts for resuscitative interventions has been proposed, but its predictive reliability has not been extensively studied. Therefore, using an expanded Apgar score reporting form is highly encouraged. This form can also be useful in cases of delayed cord clamping, where the time of birth, cord clamping, and initiation of resuscitation can be recorded. The Apgar score alone cannot be considered a specific indicator of intrapartum compromise. According to the Second Edition of the report, published in 2014, a 5-minute Apgar score of 7-10 is reassuring, 4-6 is moderately abnormal, and 0-3 is low in full-term and late-preterm infants. A score of 0-3 at 5 minutes or more may indicate encephalopathy, but it is not a specific indicator. Furthermore, the incorrect use of the Apgar score has led to an inaccurate definition of asphyxia. Asphyxia is defined as a significant impairment of gas exchange, leading to progressive hypoxemia, hypercapnia, and metabolic acidosis if prolonged. Using an expanded Apgar score reporting form is essential in accurately describing and documenting infants undergoing resuscitation. The Apgar score alone cannot be used as a specific indicator of intrapartum compromise, and its misuse can lead to a misinterpretation of the infant's condition..

[Audio] The American College of Obstetricians and Gynecologists (ACOG) has issued guidelines for the use of an expanded Apgar score reporting form. The form takes into consideration resuscitative interventions and emphasizes that the Apgar score alone cannot accurately predict mortality or neurologic outcome. The Apgar score is recorded at specific intervals of 1, 5, 10, 15, and 20 minutes after birth. The score is recorded in the appropriate place and any additional resuscitative measures are marked with a check mark. The Apgar score should not be used as the sole indicator of a baby's health. This score, along with other factors such as maternal medications and response to resuscitation, should be taken into consideration when assessing the baby's well-being. The use of this expanded Apgar score form allows for a better understanding of trends and the impact of quality improvement interventions. The application of the term "asphyxia" to birth events should be avoided unless there is clear evidence of significant impairment..

[Audio] The incidence of cerebral palsy was studied using a retrospective analysis of data from 1985 to 2004. The study found that the incidence of cerebral palsy was higher among children who received lower Apgar scores at birth. The results showed that the incidence of cerebral palsy decreased significantly as the Apgar score increased. The study also found that the incidence of cerebral palsy was higher among children born with low birth weights compared to those born with normal birth weights. The findings suggest that the Apgar score may be a useful predictor of cerebral palsy in newborns. The study concluded that the use of an expanded Apgar score reporting form can help identify high-risk infants and guide clinical decision-making. The researchers suggested that healthcare providers should consider the Apgar score when making decisions about resuscitation and treatment..