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The Apgar Score

Mind map showing summary for the Apgar score – Graphics credit: Madhero88 – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10396636

 

 

Apgar score is a method to quickly summarize the health of newborn 1) ___ against infant mortality. Dr. Virginia Apgar, an anesthesiologist at New York-Presbyterian Hospital, developed the score in 1952 to quantify the effects of obstetric anesthesia on babies. The Apgar 2) ___ is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria are summarized using words chosen to form a backronym (Appearance, Pulse, Grimace, Activity, Respiration).

 

The five criteria of the Apgar score:

Score of 0 Score of 1 Score of 2 Component of backronym
Skin color blue or pale all over blue at extremities
body pink
(acrocyanosis)
no cyanosis
body and extremities pink
Appearance
Pulse rate absent < 100 beats per minute > 100 beats per minute Pulse
Reflex irritability grimace no response to stimulation grimace on suction or aggressive stimulation cry on stimulation Grimace
Activity none some flexion flexed arms and legs that resist extension Activity
Respiratory effort absent weak, irregular, gasping strong, robust cry Respiration

 

 

The test is generally done at 1 and 5 minutes after 3) ___ and may be repeated later if the score is and remains low. Scores 7 and above are generally normal; 4 to 6, fairly low; and 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts. A low score on the one-minute test may show that the neonate requires medical attention but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test’s purpose is to determine quickly whether or not a newborn needs immediate medical care. It is not designed to predict 4) ___-term health issues. A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. Cyanosis is defined as the 5) ___ or purplish discoloration of the skin or mucous membranes due to the tissues near the skin surface having low oxygen saturation.

A study that compared babies born in Peru near sea level with babies born at very high 6) ___ (4340 m or 14,138 ft) found a significant average difference in the first Apgar score but not the second. Oxygen saturation (see pulse oximetry) also was lower at high altitude.

 

Some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

 

Spanish: Apariencia, Pulso, Gesticulacion, Actividad, Respiracion;

Portuguese: Aparencia, Pulso, Gesticulacao, Atividade, Respiracao;

French: Apparence, Pouls, Grimace, Activite, Respiration;

German: Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order (respiration, pulse, muscle tone, appearance, reflex).

 

Another eponymous backronym from Virginia Apgar’s name is American Pediatric Gross Assessment Record.

Another mnemonic for the test is “How Ready Is This Child?“, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.

 

Neonatal nursing is a subspecialty of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, “new“, and natal, “pertaining to birth or origin“. Neonatal 7) ___ requires a high degree of skill, dedication and emotional strength as the nurses care for newborn infants with a range of problems, varying between prematurity, birth defects, infection, cardiac malformations and surgical problems. Neonatal nurses are a vital part of the neonatal care team and are required to know basic newborn resuscitation, be able to control the newborn’s temperature and know how to initiate cardiopulmonary and pulse oximetry monitoring. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital. Approximately 40,000 low-birth-weight infants are born annually in the United States. In the United States, Healthcare institutions have varying entry-level requirements for neonatal nurses. Neonatal nurses are Registered Nurses (RNs), and therefore must have an Associate of Science in Nursing (ASN) or Bachelor of Science in Nursing (BSN) degree. Some countries or institutions may also require a midwifery qualification. Some institutions may accept newly graduated RNs who have passed the NCLEX exam; others may require additional experience working in adult-health or medical/surgical nursing. Some countries offer postgraduate degrees in neonatal nursing, such as the Master of Science in Nursing (MSN) and various doctorates. A nurse practitioner may be required to hold a postgraduate degree. The National Association of Neonatal Nurses recommends two years’ experience working in a NICU before taking graduate classes. 8) ___ nurses must complete the Neonatal Resuscitation Program. Some units prefer new graduates who do not have experience in other units, so they may be trained in the specialty exclusively, while others prefer nurses with more experience.

 

Intensive care nurses receive intensive didactic and clinical orientation, in addition to their general nursing knowledge, to provide highly specialized care for critical patients. Their competencies include the administration of high-risk medications, management of high-acuity patients requiring ventilator support, surgical care, resuscitation, advanced interventions such as extracorporeal membrane oxygenation or hypothermia therapy for neonatal encephalopathy procedures, as well as chronic-care management or lower acuity cares associated with premature infants such as feeding intolerance, phototherapy, or administering antibiotics. NICU RNs undergo annual skills tests and are subject to additional training to maintain contemporary practice.

 

The Apgar scoring system was intended as an evaluative measure of a newborn’s condition at and of the need for immediate attention. In the most recent past, individuals have unsuccessfully attempted to link Apgar scores with long-term developmental outcomes. This practice is not appropriate, as the Apgar score is currently defined. Expectant parents need to be aware of the limitations of the Apgar score and its appropriate uses. The Apgar score is performed at 1 and 5 minutes of 9) ___10) ___ scoring is best used in conjunction with additional evaluative techniques such as physical assessment and vital signs.

 

ANSWERS: 1) babies; 2) scale; 3) birth; 4) long; 5) bluish; 6) altitude; 7) nursing; 8) Neonatal; 9) life; 10) Apgar

 

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