The Apgar scale for assessing the basic vital functions of a newborn child is an optimal system that allows you to determine in the shortest possible time whether the baby needs urgent measures to stabilize his condition.
The Apgar scale was presented by the American anesthesiologist Virginia Apgar at a medical conference back in 1952. The doctor recommended this neonatal assessment system to determine the need for resuscitation procedures in the first minutes of a baby's life. The system did not immediately become popular, and was initially used only in the clinic where its author worked. But when the percentage of newborns rescued thanks to the Apgar scale exceeded 70, it spread throughout the world and became mandatory for use in all medical facilities.
Description of the method
At the moment, the Apgar scale is the only objective method for determining the basic functions of a child's vital activity immediately after his birth. It allows you to immediately provide emergency assistance to the baby, to prevent the development of complications after childbirth. The essence of the method lies in the digital reflection of the most important functions:
Skin color, Heart rate, Reactions to external stimuli, The ability of muscles to contract and relax, · The number of breaths and breaths.
The assessment of the baby's condition on the Apgar scale is carried out twice - in the first and fifth minutes of life. The received data are summed up, and a single indicator in the range of up to 10 points is displayed.
It is noteworthy that the assessment of the child's condition does not require the use of any medical instruments or apparatus, the presence of a team of highly specialized doctors. A gynecologist or obstetrician who delivered a childbirth or a pediatrician can carry out manipulations and display data. Based on the score obtained during the Apgar scale check, a decision is made on further observation of the newborn, the need for resuscitation measures, their complexity and duration.
Methods for assessing the main indicators on the Apgar scale
10 years after the method for assessing the condition of the newborn was described by its author, a more perfect model was presented by pediatrician Joseph Butterfield. The essence of the technique remained the same, the doctor only slightly modified it, facilitating the assessment process itself and streamlining the actions:
A (Appearance) - skin color, P (Pulse) - pulse, G (Grimace) - reflexes, A (Activity) - activity (muscle tone), R (Respiration) - breath.
The first stage - all skin integuments are examined, their color is determined. After that, the heart rate (pulse) is calculated. The next step is to determine the presence of basic reflexes, sucking and swallowing. This is followed by an assessment of motor movements, facial expressions, general activity of the baby. The highest score is given to a newborn who screams and randomly moves his arms, legs, and turns his head. The last stage - fixing the frequency of inhalation-exhalation - allows you to determine how deeply the baby is breathing, whether his lungs have fully opened.
Clinical signs and their assessment on the Apgar scale
Each delivery room must have an Apgar scale table, which indicates the main clinical indicators and the rules for their assessment in points. The data are standard, the expectant mother can easily remember them:
· Skin color - 0 points for cyanosis, 1 - pink body, blue limbs, 2 points - pink body, arms and legs;
· Heartbeat - 0 points in its absence, 1 point at 100 beats per minute, 2 - if the pulse exceeds 100;
Reflexes - 0 points if there is no reaction to touch, 1 point - weak movements, no grimaces, 2 points - the presence of a loud cry, facial expressions, coughing, sneezing, reactions to tickling legs, nasal catheter;
Muscle tone - 0 points with a complete lack of movement, a relaxed body and hanging limbs, 1 - with sluggish movements and reactions, 2 - if the baby is active;
Breathing - 0 if the baby is not breathing, 1 point - with irregular breathing and weak cry, 2 points - normal breathing and loud cry.
The assessment procedure is as follows - the doctor examines the newborn, names the points, and the nurse records the data in the baby's card. If the total scores are low, a resuscitator is called into the delivery room, together with whom the child's condition is re-assessed according to the Apgra scale and appropriate measures are taken to support his life.
How the Apgar scale totals are deciphered
The Apgar scale is the most informative and allows you to assess the state of the baby in the first minutes of his life as objectively as possible, to make predictions both for the near future and for the success of development in general. The data obtained during this examination are entered in the discharge from the hospital and the child's medical book in the form of a single digital indicator, that is, the parents of the newborn can also familiarize themselves with them. The indicators of the vitality of a newborn on the Apgar scale are deciphered simply:
0-2 points - a critical situation, the need for urgent resuscitation actions, constant monitoring of pediatricians and narrow medical specialists after discharge, 3-6 - a satisfactory condition with minor deviations, characteristic of premature babies, requiring the close attention of a pediatrician, 7-9 points - the optimal indicator confirming that the baby is healthy and does not need medical supervision,
· 10 points is the best indicator, but in Russia it is rarely exhibited, since specialists do not want to take responsibility and claim that the baby is absolutely healthy.
After discharge, not only the parents of the newborn, but also the pediatrician, the patronage nurse at the place of residence of the baby must familiarize themselves with the indicator. On the basis of these very data, decisions are made on the frequency of visiting the child at home by a medical specialist, a vaccination schedule is drawn up, procedures and consultations of narrow specialists are prescribed - a pulmonologist, a cardiologist, a neonatologist, a neurologist, a surgeon and others.
Apgar score and predictions for a newborn
A two-fold assessment of the state of the newborn on the Apgar scale is carried out in order to determine the dynamics of the baby's development in the first minutes of life. This allows you to track possible violations in the work of vital organs, and on the basis of the data obtained, a forecast of the general development of the child is formed.
The lowest overall score (from 0 to 2) should not cause parents to panic. Modern medicine is able to take care of even children with such indicators. If a newborn is given a score from 0 to 2, he is immediately assigned a complex of resuscitation measures, which may include:
Immediate connection to a ventilator, Installation of an external pacemaker, Suitable methods of intensive care, · Artificial feeding through a catheter.
98% of children born with low indices of vital activity on the Apgra scale survive and easily adapt in society, have no deviations either psychologically or physiologically from their peers. The only thing they will need is regular supervision by a medical professional.
The data obtained during the examination of the baby on the Apgar scale are reported to the young mother immediately after the manipulations. In addition, the decision on further actions is also voiced if the woman in labor is able to perceive them. As a rule, information is delivered again after the mother is transferred from the delivery room to the ward with or without the baby.
