Pediatric Spotlight: The Newborn & What does the APGAR score actually mean?

http://images.google.com/imgres?imgurl=http://digital-photography-school.com/wp-content/uploads/2009/03/baby-photography-02.jpg

So this semester I am taking a pediatric/geriatric class and I find it very interesting.  I thought that I might like to do a spotlight on the various stages of a baby/child's life.  I am sure most of my mom-friends probably know most of this already, but maybe it will be interesting from a medical standpoint.  I would like to endeavor to answer what does all of it mean and why practitioners do what they do?  So for today I am spotlighting "THE NEWBORN" (i.e. transition to Extrauterine Life).

http://www.andrewsmcmeel.com/anne-geddes/special-baby.html

The PGAR score was devised by Dr. Virginia Apgar just after WWII in 1953.  Ms. Apgar was a student of Columbia University Medical School.  In 1929 She was one of 8 women in the class with 81 male classmates (YAY for women doctors!!).  She developed this system after watching many deliveries and doctors often giving up quickly on struggling babies. At this time 1 in 30 births ended in death.  Dr. Apgar never married. Her entire life, she was famous for intelligence, energy, empathy and a great sense of humor. She was still working on behalf of the most vulnerable babies when she died in 1974, at the age of 65, of liver failure.  (source: http://birthstory.net/people/the-mother-of-the-apgar-score/)

 http://birthstory.net/wp-content/uploads/2010/03/virginia_apgar.jpeg

Her invention of the score transformed delivery. The APGAR  is a 10-point scale for assessing how a newborn baby is doing — first with the birth process, and then with adjusting to the world. It is given in hospitals one minute after birth, and again at five minutes. A robust baby might garner 10 points, but a baby with an Apgar score of four or less draws serious concern and, likely, vigorous intervention. (source: http://birthstory.net/people/the-mother-of-the-apgar-score/)

APGAR stands for Appearance, Pulse, Grimace, Activity and Respiration. 

The APGAR score is an instrument used to assess the HEALTH of the newborn. It is administered at 1 & 5 minutes (sometimes 10) after birth. The scoring utilizes the following measures:

Activity (muscle tone)
0 — Limp; no movement
1 — Some flexion of arms and legs
2 — Active motion

Pulse (heart rate)
0 — No heart rate
1 — Fewer than 100 beats per minute
2 — At least 100 beats per minute

Grimace (reflex response)
0 — No response to airways being suctioned
1 — Grimace during suctioning
2 — Grimace and pull away, cough,
or sneeze during suctioning

Appearance (color)
0 — The baby's whole body is completely bluish-gray or pale
1 — Good color in body with bluish hands or feet
2 — Good color all over

Respiration (breathing)
0 — Not breathing
1 — Weak cry; may sound like whimpering, slow or irregular breathing
2 — Good, strong cry; normal rate and effort of breathing 

http://www.layoutsparks.com/1/95969/miracle-baby-lovely-crying.html

The scoring  is a great indicator of the babies progression and is very helpful for the practitioner, in knowing when to intervene.  A baby who scores low at minute 1 can often score high at 5 minutes and therefore it is the progression that is important.  I know 1 & 5 minutes seems very quickly after birth, but a baby is designed so perfectly that all of these processes should occur instantaneously and when they don't a time period of 5 minutes is a great length of time. 

http://images.google.com/imgres?imgurl=http://blogs.theage.com.au/managementline/archives/syd-5aerlntueyg1b1urwbro_layout.jpeg

Another score you might have heard of before is called the Ballard Maturation Score. This score was developed by Dr. Ballard and revised in 1991. This is a method of scoring physical maturity and neurological maturity in order to assess the actual gestational age of the baby between the ages of 26-44 weeks. Although we usually have a good idea of the age of a newborn baby, it is often important to perform this scoring in order to ensure the correct age of the baby or re-assign the correct age (i.e. 37 wks vs 39 wks).

The Ballard score relies heavily on natural reflexes and movements of the baby, the scoring relies on the intra-uterine changes that the fetus undergoes during its maturation. The  premature baby would have lesser muscle tone (more flexible... see scoring below of  0-1) than an older baby.

http://images.google.com/imgres?imgurl=http://eso-cdn.bestpractice.bmj.com/best-practice/images/bp/671-3-iline_default.gif

The above picture shows the NEUROLGICAL scoring.  

The PHYSICAL scoring includes: skin, ears, eyes, fine hair and more.

The scores range from 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. An increase in the score by 5, increases the age by 2 weeks.

The correct gestational age is important to interpret, because as baby grows and develops they should be compared to those of the same gestational age.  This will ensure they will not be considered "slow" because it only makes sense that a premature baby at 3 months old, will most likely not be progressing or as active as a non-premature baby of  3 months old. Therefore a premature-3-month-old is most likely progressing on track and normally, vs. slowly when compared to their peers of "normal" 3 months of age.

http://images.google.com/imgres?imgurl=http://artfiles.art.com/5/p/LRG/22/2221/TUNAD00Z/anne-geddes-cabbage-kids.jpg

I hope this was enlightening, helpful and informative!

Enjoy, Kim