Apgar-Score

The Apgar score is a point system, with which the clinical condition can be assessed by standardized newborn. With the help of this assessment of the condition of the baby and its adjustment to life outside the womb, so the transfer of fetal in the neonatal state is described. Next can be the effect of resuscitation describe. The score was introduced in 1952 by the U.S. anesthesiologist Virginia Apgar and named after her. A second report with a larger number of patients was published in 1958.

Medicine Historical background

Newborns may die from complications during pregnancy or during birth, so undiagnosed prenatal damage worsened after birth, or as a result of defects or injuries during birth, such as cerebral hemorrhage, oxygen deficiency, or a combination of such damage.

Before applying the Apgar scores, there was no uniform global approach to the monitoring and evaluation of the most important vital signs of newborns. Respiratory and circulatory problems can often often lead to lifelong consequences or death of the child, although they often can be treated successfully if they would have been detected immediately after birth.

Virginia Apgar wrote in her book " Is my Baby All Right? '

Implementation

The Apgar score has five components:

The determination is performed, five, ten and 60 minutes after birth. The feature of each 0 points 2 points ( feature good present) are ( feature absent), 1 point ( feature not pronounced ), or assigned and entered into the study protocol; the maximum score is 10 Displays the "mature" newborns, that is, after 37 completed weeks of pregnancy, no problems and it has adapted well, it stays on the maternity ward in the mother.

The optimal score for newborns are 9-10 points, with the "missing" point after one minute is usually attributed to the bluish skin color. In the scoring 5-8 between the newborn is considered endangered, live at risk than acute in under 5.

Limitations

The Apgar score describes the physiological and pathophysiological condition of the baby within a limited period of time. It also includes subjective components.

  • The score may by drugs, infections, birth trauma, congenital abnormalities, hypovolemia and the like. be affected.
  • The maturity of the child also affects the Apgar score. Premature babies can only be judged inadequate by the score, because features such as breathing, muscle tone and reflexes are gestational age dependent. Thus, a healthy premature infant without signs of asphyxia may therefore only receive a low Apgar score, because it is immature. The frequency of a low Apgar scores is inversely proportional to the birth weight.
  • The score can not be used to predict neurological complications in term infants, although this is falsely tried again and again (see Beller / Holzgreve ). Other factors, such as suspicious CTG, pathological changes in the umbilical cord blood gas, Pathology of the placenta, hematological findings, EEG of the newborn, ultrasound and X-ray, neurological dysfunction and multiple organ failure must be taken into account when hypoxia (Eng. oxygen desaturation ) during birth as a cause will be accepted for cerebral palsy.
  • The score also is not sufficient alone to make the diagnosis of asphyxia. Therefore, a low Apgar score does not allow prediction of morbidity and mortality.
  • There is a distinct difference between an Apgar score, which is charged during a rescue, and a score in a spontaneously breathing neonates, because the components of the score are influenced in large part by the CPR.

Expanded Apgar score

A 2006 by the ACOG ( American gynecologists society ) proposed extended Apgar score takes into account also the results of resuscitation. However, these data are also documented in each resuscitation protocol. The extended Apgar score takes into account the monitoring of the child to 20 minutes.

Meanwhile, the scaling is changed and you can reach a maximum of 10 points per feature. A value of 7-10 (after 5 or ten minutes) are "very good." The value after the first minute is rather neglected today.

Acronyms

Germany

In Germany, the method is now more commonly used; However, there is an additional tool, because there are already early childhood provided U1 and U2, the use of the second hour of life.

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