The child receives the first marks not even at school, but in the delivery room. Yes, those same mysterious figures - Apgar scores. The classic rule applies here - the higher the score, the better. But what if the obstetrician gave the newborn only 7/9 or 8/9 on the Apgar scale? Is this a good thing or an urgent need to panic? And why didn't the kid become an "excellent student", having received the coveted 10/10? Let's figure out what points doctors give to babies who are just born.
Why do you need the Apgar scale
Anesthesiologist Virginia Apgar from America suggested that newborns score points. And this rating system has been successfully operating since 1952. The scale was "conceived" as an aid to nurses and midwives - by assessing the condition of children according to five indicators, they could understand which of them needed more attention. Later, checking on the Apgar scale began to be included in the list of mandatory medical procedures that are carried out with a newborn. And as doctors say, she saved many lives.
The Apgar scale, if you compare with medical terminology, is a system for assessing the condition of a newborn in order to identify the need for certain resuscitation procedures.
How the Apgar scale "works"
Total Apgar scores are one of the three main parameters that are reported to the parents of the baby, along with his weight and height. Moreover, these assessments are given immediately after the birth of the child. Thus, the obstetrician concludes about the general condition of the newborn - whether he needs urgent help from doctors. And if so, to what extent and how much.
- According to the established rules, a child is tested on the Apgar scale by assessing five main signs. Joe Butterfield, a pediatrician from America, in 1962 proposed to designate them by the first letters of the surname Virginia Apgar. So what criteria are being evaluated?
- Appearance / skin color (skin tone). A child's skin can have a different shade - from pale to bright pink. The obstetrician examines the baby's torso and limbs, in some cases the whites of the eyes and mucous membranes of the mouth. Ideally, the color of the child's skin should be uniform, close to pink, with no cyanosis in large areas of the body (on the limbs it is allowed).
- Pulse (heart rate). A baby's heart beats more often than an adult's - up to 130-140 beats / min. If the baby was deficient in oxygen in the womb or directly during childbirth, along with other vital indicators, his pulse also changes. Doctors may be alarmed by a heart rate of less than 100 beats / min.
- Grimace / reflexes (reflex excitability). This is the newborn's reaction to the suction of mucus from the upper respiratory tract. Some of the kids react weakly to these manipulations - only with a grimace on their face. And others cry, cough and sneeze - just this level of reflex excitability is considered optimal for a newborn. This reaction of the newborn to external stimuli is his very first reflexes.
- Activity / muscle tone (muscle tone). Infants have increased limb tone, which is considered normal. Hence the posture of the newborn - the head is tilted to the chest, the fists are clenched, the arms and legs themselves are bent at the elbows and knees. The movements of the baby's limbs should be chaotic, albeit quite active. If the doctor observes a slight degree of flexion of the arms and legs, the Apgar scores will be lower.
Respiration. A newborn can make 40-45 breaths per minute. At the same time, he also screams. If the child's breathing is slower than normal and he makes sounds that are more like moans than a full cry, the marks will be lowered.
How children are scored
During the examination, for each sign according to the Apgar system - skin tone, respiration and pulse rate, reflexes and muscle tone - a newborn can be given 0, 1 or 2 points. Then they are summed up.
Moreover, the assessment of the physical condition is carried out twice - at the 1st and then at the 5th minute of the baby's life. This is where these two digits, written sequentially through the fraction sign, come from - for example, 7/9 or 8/10.
The first number is the assessment that the child "deserved" immediately after birth, the second - at the 5th minute of life. The second point is considered the main one, on which the doctors are guided later. Usually these estimates are slightly higher than the first.
In some cases, if the newborn has very low indicators, his condition is checked even at the 10th minute of life. Usually after a series of medical procedures to stabilize the baby's condition. Then the third digit appears in the designation - for example, 5/6/8.
The score "0" is the lowest. Means that the baby does not have a specific sign at all. Score "1" - the average score for one parameter or another. Score "2" is the maximum possible. Means that the child has all the vital signs clearly expressed. If the doctor gave the newborn the maximum score for each of the criteria, the “cherished” ten is gained.
It is believed that usually in children born by caesarean, the Apgar score is slightly higher than in those born in natural childbirth.
Deciphering the points assigned to the child
Apgar scores are not necessary at all to make a mother even more proud of her child. First of all, this information is important for doctors. The assigned points will help doctors to react faster, to provide the newborn with medical care - right in the maternity ward or already in intensive care. It all depends on how difficult the situation turned out to be. That is why babies are checked even before they are given to their mother.
The total value of points on the Apgar scale can be deciphered as follows:
- 0-2 points. The baby is in critical condition, he urgently needs the help of resuscitators.
- 3-4 points. These indicators are observed in many babies born long before the due date. Most often, they need immediate action by resuscitators and medical supervision.
- 5-6 points. Satisfactory assessment of the condition. The health of the child requires strict monitoring by doctors.
- 7-9 points. Positive result. The newborn is in good condition, does not need any specific medical intervention.
- 10 points. Excellent result.
Doctors say that full-term babies usually score 7 or higher on the Apgar scale. This is a good result, there is no cause for concern. But children rarely get the maximum “top ten” in the first minute of their lives. Closer to the 5th minute, the child quite "holds out" to the highest mark.
Low scores are mainly associated with hypoxia or asphyxia in a child. Oxygen starvation leads to numerous complications - the baby has a weak heartbeat, he shows unsatisfactory reflexes to external influences.
Less often, the reason for "bad" ratings is the physiological immaturity of the baby. He is lethargic, shows a weak tone. For an infant with low scores at the 1st minute of life, their positive dynamics is extremely important. Ideally, by the 5th minute, the scores should be at least 1-2 points higher. Then we can confidently talk about a positive forecast.
If no resuscitation actions are required in relation to the baby, but his condition still does not improve, the doctor takes him "under control" - most likely, additional tests and examinations will be required.
Apgar scale - a subjective assessment of the physical condition of a newborn
Apgar scores are not a diagnosis! It would be a mistake to think that the maximum ten is a guarantee that the baby in the future will never get sick, and he will not be affected by various kinds of pathology.
Likewise, with an unsatisfactory assessment of the physical condition - if the baby was given a mark of "5" or "6" in the 1st minute, this does not mean that he "will not get out." There is no scientific evidence proving that low Apgar scores in a newborn are somehow related to his physical and mental development in the future.
The main purpose of scoring a baby is to track his condition immediately at the time of birth.
It is not uncommon for children who received satisfactory 6 and 7 Apgar scores in the maternity ward to go home in better condition than those who received higher scores in the first minutes of their lives.
Doctors do not make any "long-term" predictions without additional research, based only on the Apgar scale. A simple example. The baby was born prematurely, but his pulse rate is normal, he screams and actively moves his limbs. In general, it "deserves" 7 points on Apgar. But resuscitators know that, most likely, the condition of the newborn will worsen in half an hour - right up to connecting it to a ventilator.
Despite the sufficient subjectivity of the Apgar scale, the medical community is not going to abandon it. Dozens of years have passed, but so far no faster and more accurate methods have been proposed for assessing the physical condition of a newborn. At least for doctors, these points are very important.
To determine those indicators that help to more thoroughly check the health of the baby, there are other methods. For example, the Silverman scale assesses the degree of respiratory distress in premature babies. And according to the Ballard scale, you can track the child's compliance with physiological norms.