Pathology
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Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
Developed by Dr. Virginia Apgar, an anesthesiologist, in 1953 for the purpose of providing a simple, clear classification or grading of newborn infants which can be used as a basis for discussion and comparison of the results of obstetric practices, types of maternal pain relief and the effects of resuscitation.
Body | 0 | 1 | 2 |
Heart action | None | Under 100/min | Over 100/min |
Breathing | None | Slow, irregular | Regular, cry |
Muscle tone | None | Weak | Normal |
Reaction to irritation | None | Grimase | Cry |
Skin color | General cyanosis and paleness | Acrocyanosis | Pink |
The scoring system comprises 5 signs: heart rate, respiratory effort, muscle tone, reflex irritability and color, each of which is given zero, one or two points. The total score ranges from zero to ten points.
The baby is scored at 1, 5 and 10 minutes after birth.
A score of 7 – 10 is considered normal, 4 – 7 intermediate, 0 – 3 poor; the infant requires immediate resuscitation
The Apgar score significance
Rapid standardized assassement of the clinical status of the newborn infant and the need for prompt resuscitation A change in score is a useful index of the response to resuscitation. On the other hand the Apgar score has limitations. It is affected by gestational age, maternal medication, resuscitation, congenital anomalies, infections and trauma.
Apgar score in preterm infants
Signs as tone, color or reflex irritability paritally depend on the physiologic maturity of the infant. The healthy preterm infants may receive a low score only because of immaturity.
Apgar score and asphyxia
In is innapropriate to use an Apgar score alone to establish the diagnosis of asphyxia. Other factors such as abnormalities in umbilical arterial blood gases, clinical cerebral function, placental pathology and multisystem organ dysfunction need to be considered.
Apgar score and prediction of neurological outcome in the term infant
A low 1-minute Apgar score alone does not correlate with the infants future outcome. An Apgar score of 0 to 3 at 5 minutes may correlate with neonatal mortality but alone does not predict later neurologic dysfunction. (75% of children with cerebral palsy have normal scores at 5 minutes). The risk of poor neurological outcome increases when the Apgar is 3 or less in 10, 15 and 20 minutes.