Apgar Testing Health Article

Definition

Apgar testing is the assessment of the newborn rating color, heart rate, stimulus response, muscle tone, and respirations on a scale of zero to two, for a maximum possible score of 10. It is performed twice, first at one minute and then again at five minutes after birth.

Purpose

Apgar scoring was originally developed in the 1950s by the anesthesiologist Virginia Apgar to assist practitioners attending a birth in deciding whether or not a newborn was in need of resuscitation. Using a scoring method fosters consistency and standardization among different practitioners. A February 2001 study published in the New England Journal of Medicine investigated whether Apgar scoring continues to be relevant. Researchers concluded that "The Apgar scoring system remains as relevant for the prediction of neonatal survival today as it was almost 50 years ago".

Description

The five areas are scored as follows:

• Appearance, or color: 2 if the skin is pink all over; 1 for acrocyanosis, where the trunk and head are pink, but the arms and legs are blue; and 0 if the whole body is blue. Newborns with naturally darker skin color will not be pink. However, pallor is still noticeable, especially in the soles and palms. Color is related to the neonate's ability to oxygenate its body and extremities, and is dependent on heart rate and respirations. A perfectly healthy newborn will often receive a score of 9 because of some blueness in the hands and feet.
• Pulse (heart rate): 2 for a pulse of 100+ beats per minute (bpm); 1 for a pulse below 100 bpm; 0 for no pulse. Heart rate is assessed by listening with a stethoscope to the newborn's heart and counting the number of beats.
• Grimace, or reflex irritability: 2 if the neonate coughs, sneezes, or vigorously cries in response to a stimulus (such as the use of nasal suctioning, stroking the back to assess for spinal abnormalities, or having the foot tapped); 1 for a slight cry or grimace in response to the stimulus; 0 for no response.
• Activity, or muscle tone: 2 for vigorous movements of arms and legs; 1 for some movement; 0 for no movement, limpness.
• Respirations: 2 for visible breathing and crying; 1 for slow, weak, irregular breathing; 0 for apnea, or no breathing. A crying newborn can adequately oxygenate its lungs. Respirations are best assessed by watching the rise and fall of the neonate's abdomen, as infants are diaphragmatic breathers.

The combined first letters in these five areas spell Apgar.