In the article, we will consider how the condition of the newborn is assessed according to the Apgar scale in obstetrics.
Immediately after birth, the obstetrician determines the basic indicators of the baby's life support. This is necessary to understand the need for resuscitation and a general assessment of the vital parameters of the newborn. Such an assessment is an important aspect for further actions of medical specialists. There is a single system of assessment, the so-called Apgar scale, which is used in many countries.
Algorithm
Evaluation of the state of the newborn on the Apgar scale makes it possible to establish the vitality of the child immediately after birth. This technique is more than 65 years old, it was developed by American anesthesiologist Virginia Apgar. At the same time, the namethe scale itself has a double meaning. It not only contains the name of the person who developed the scale, but also the first letters of the main indicators translated into English, namely:
1. Appearance - skin tone.
2. Puls - the frequency of contractions of the heart muscle.
3. Grimace - mimic congenital reflexes.
4. Activity - activity of muscle tissue.
5. Respiration - respiratory function.
Each indicator is scored on a scoring system from 0 to 2, which suggests the following:
1. 0 – absence of an estimated feature.
2. 1 – weak expression of the evaluated criterion.
3. 2 - pronounced criterion, norm.
Scores for all considered parameters are summarized. If the Apgar score of the newborn is low, specialists decide on emergency care for the child, which may include transfusion procedures, mechanical ventilation, and placement of the newborn in a special box that can support vital body functions.
Evaluation of the state of the newborn on the Apgar scale is carried out immediately after the birth of the child, in the first minutes of life. This is done in order to provide first aid if necessary. The test is then repeated after five minutes. In this case, the child's ability to adapt to the new living conditions surrounding him is monitored.
All results are entered into a special table in the form of twocolumns of numbers, which can either differ (the indicators of the second test are higher than in the first case) or remain unchanged. The resulting table is entered into the documents issued upon discharge of the child. They are further used by the district pediatrician to collect an anamnesis during the first year of a baby's life.
Let's consider indicators for assessing the state of the newborn on the Apgar scale.
Indicators for monitoring
Apgar examination of a newborn should be performed by a physician. As a rule, the most important test parameter is the degree of oxygen starvation of the fetus. It is necessary to carry out the check very quickly, as significant deviations from the normal values \u200b\u200bmay require urgent action. In case of delay, we can talk about serious consequences for the he alth of the child and even his life. The main parameters of the norm in assessing the state of the newborn on the Apgar scale are given below.
Respiratory function
The normal breathing rate for a newborn is 40-45 times per minute. Crying is loud and well audible. A decrease in the score occurs if breathing is slow and uneven, and instead of a full-fledged cry, only trembling of the vocal membranes is heard. In this case, the child is provided with additional oxygen through a special installation. A situation is considered critical when the respiratory function is not observed, which requires urgent measures aimed at restoring it and connecting it to a ventilatorlungs.
Heart rate
Immediately after the birth of a baby, his heart beats faster, as when passing through the birth canal, there is an increased load on the baby's body. If the heart rate is more than 100 beats per minute, namely 130-140, this indicates normal performance and the maximum score on the scale. When the supply of oxygen to the child's body is limited, respiratory depression occurs, the heartbeat slows down to less than 100 beats per minute. In this case, the score is 1 point. The absence of heart beats is indicated by a zero score on the scale.
Muscle tone
This indicator is increased in newborns, and this is considered the norm. The fact is that during the period of gestation, the fetus is in one static position. After birth, freedom of the limbs appears, and the child randomly and abruptly moves his legs and arms, which indicates a good muscle tone. In some cases, doctors observe grouping with legs and arms pressed tightly to the body, imitating the posture in the womb. One point indicates the bent arms and legs of the child, who occasionally makes small movements. Also, a low score indicates the absence or weak resistance when the doctor tries to move the child's limbs. If movement activity is zero, no points are awarded.
Reflexes
Their unconditional variety must be present immediately after birth. This may be the first breath or a cry, which is scored according to the highest score. If reflexesbelated and appear as a response to resuscitation, one more is added to the total scores. The complete absence of reflexes is indicated by a zero point.
Skin tone
The normal skin color of a newborn baby is pink. It is this shade that indicates the correct functioning of the circulatory system. As a rule, the correct shade of the skin is observed in children born by cesarean section, which is explained by the low probability of oxygen starvation, which often accompanies the passage through the mother's birth canal. A decrease in the score on the scale is due to the discovery of a bluish hue of the skin on the feet and palms of the newborn, as well as the mucous membrane of the oral cavity and lips. If a significant area of the child's skin is cyanotic or pale blue, no points will be awarded.
Deciphering the results obtained
The maximum number of points a child can receive on the Apgar scale is ten. Such an assessment is extremely rare, only in 10-15% of cases. A similar indicator according to Apgar is considered a reference and is even more rare in our country, due to the level of he alth care and mentality. Medical specialists abroad often give such assessments. At the same time, even an absolutely he althy child can find a reason to reduce points, for example, with cyanosis of the hands or feet.
It should be borne in mind that the sum of the points obtained in assessing the state of the newborn on the Apgar scale is notindicates good or bad he alth of the child, and is not a characteristic of mental development or a method of diagnosis, it only indicates the ability of the infant to live. If the result of the Apgar score does not approach zero, it cannot affect the future he alth of the child. This express method allows you to diagnose the child's condition at the time of the check, and also makes it possible to determine the need for urgent action.
What, for example, does a newborn baby's Apgar score of 7 mean? Risk groups will be discussed below.
Let's consider examples of ratings:
1. 0-3, 3-3. The child's condition is critical, severe asphyxia is observed, resuscitation measures must be taken.
2. 4-5. In this case, monitoring of indicators in dynamics is required. Such scores indicate moderate asphyxia.
3. 6-7. Mild asphyxia, there is no threat to the child's life.
4. 7-7, 7-8. Moderate condition, close monitoring and control is not required.
5. 8-8. The child's he alth is rated above average, the scores decrease due to the fact that some aspects are weaker than others, but not critical.
6. 8-9, 9-10. The child's condition is assessed as good, all reflexes and systems of the baby's body are working normally.
If the score is low
If the assessment of the condition of the child immediately after birthlow, doctors begin to carry out resuscitation actions aimed at normalizing the indicators. If after five minutes the score on the scale does not rise to 6-7 points, further monitoring of the child's condition is carried out until the optimal result is achieved. As a rule, 15 minutes is enough to get positive dynamics.
If the child's performance does not exceed 6 points after 15 minutes, it is determined in stationary conditions. An extract occurs after the condition of the newborn stabilizes. Disturbances in the functioning of the nervous system are eliminated after some time, even if the scores on the scale are quite low.
Prematurity and risk groups in assessing the state of the newborn on the Apgar scale
Most often the lowest rating is given to children who are deficient in oxygen. This condition can be caused by chronic hypoxia, malformations in the fetus, as well as a complicated course of the birth process.
Another reason for a low score on the scale may be prematurity. The child is evaluated according to standard parameters, while a baby born prematurely cannot a priori meet them. Therefore, the number of points for premature babies often does not exceed six. You should not be afraid of such low indicators, they are not a criterion for assessing the state of he alth and development of the child as a whole.
Assessment of the child's condition on the Apgar scale is mandatory.
Systemic disorders and pathologies are not detected by this test. This scale only allows you to assess the state of viability of the child at the time of birth. In the future, more research will be needed to determine the he alth status of the baby.
We reviewed the algorithm for assessing the state of the newborn on the Apgar scale.
