Apgar Testing

Apgar Testing 

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:

The combined first letters in these five areas spell Apgar.

Preparation

No preparation is needed to perform the test. However, while being born the neonate may receive nasal and oral suctioning to remove mucus and amniotic fluid. This may be done when the head of the newborn is safely out, while the mother rests before she continues to push.

Aftercare

Since the test is primarily observational in nature, no aftercare is needed. However, the test may flag the need for immediate intervention or prolonged observation.

Normal results

The maximum possible score is 10, the minimum is zero. It is rare to receive a true 10, as some acrocyanosis in the newborn is considered normal, and therefore not a cause for concern. Most infants score between 7 and 10. These infants are expected to have an excellent outcome. A score of 4, 5, or 6 requires immediate intervention, usually in the form of oxygen and respiratory assistance, or perhaps just suctioning if breathing has been obstructed by mucus. While suctioning is being done, a source of oxygen may be placed near, but not over the newborn's nose and mouth. This form of oxygen is referred to as blow-by. A score in the 4-6 range indicates that the neonate is having some difficulty adapting to extrauterine life. This may be due to medications given to the mother during a difficult labor, or at the very end of labor, when these medications have an exaggerated effect on the neonate.

Abnormal results

With a score of 0-3, the newborn is unresponsive, apneic, pale, limp and may not have a pulse. Interventions to resuscitate will begin immediately. The test is repeated at five minutes after birth and both scores are documented. Should the resuscitation effort continue into the five-minute time period, interventions will not stop in order to perform the test. The one-minute score indicates the need for intervention at birth. It addresses survival and prevention of birth-related complications resulting from inadequate oxygen supply. Poor oxygenation may be due to inadequate neurological and/or chemical control of respiration. The five-minute score appears to have a more predictive value for morbidity and normal development, although research studies on this are inconsistent in their conclusions.

Resources

Books

Feinbloom, Richard I. Pregnancy, Birth and the Early Months. Cambridge, MA: Perseus Publishing, 2000.

Pillitteri, Adele. Maternal & Child Nursing; Care ofthe Childbearing and Childrearing Family. 3rd ed. Philadelphia: Lippincott, 1999.

Periodicals

Casey, B. M., D. D. McIntire, and K. J. Leveno. "The Continuing Value of Apgar Score for the Assessment of Newborn Infants". New England Journal of Medicine 344 (February 15, 2000): 467-71.

Other

Apgar, Virginia. A Proposal for a New Method of Evaluation of the Newborn Infant. http://www.apgarfamily.com/Apgar_Paper.html.

The National Childbirth Trust. http://www.nctpregnancyandbabycare.com.

PregnancyWeekly.com http://www.pregnancyweekly.com.