Birth Injury

What Is An APGAR Score?

Every baby gets an APGAR score, but as a parent, it can be a completely foreign topic that leaves you worried and confused, especially if your infant ends up getting a low score. To help you better understand the APGAR scoring method and what it does, here are some quick answers to the most common questions.

What Does APGAR Stand For?

APGAR’s explanation is simple and straightforward. It measures some key vital signs following your baby’s birth.

  • A stands for Appearance (skin color)
  • P stands for Pulse (heart rate)
  • G stands for Grimace response (reflexes)
  • A stands for Activity (muscle tone)
  • R stands for Respiration (breathing rate and effort)

Your baby’s APGAR score is what doctors will use to check their heart rate, to check their muscle tone, and to look for other signs that may indicate that your baby requires additional medical care or emergency care.

The APGAR test is a standard procedure and it is administered for every infant, however, your baby’s score will determine how medical staff care for your baby during their first few days at the hospital. The test is always given twice, but if there are concerns, it may be given more than twice.

Why Was The Test Created?

The APGAR score is used to check some key signs of your newborn baby, but keep in mind that most babies rarely gets a perfect score and it should not cause alarm if your baby does get a low score. A low score just indicates to doctors that they need to look for potential issues so that your infant can be cared for the best.

Generally, the APGAR score is a baby's first assessment. Its purpose is to check their basic health, like heart rate, but it's not an indicator (in any way) of your baby's future behavior or intellect. The test is only a basic assessment to help doctors provide your baby with the highest level of care.

The test itself was developed all the way back in 1952 by Virginia APGAR, an obstetric anesthesiologist. It is a standard tool by which all newborn babies are assessed.

What Is APGAR Used For?

In short, the APGAR test is a quick assessment of your newborn's physical wellness. It will help medical staff determine if present or future medical care may be required for your baby in addition to the standard care that infants receive.

When Is The APGAR Test Performed?

It is standard procedure for every doctor to perform the APGAR test on a newborn baby. The test is actually performed twice. First, the APGAR test is performed right after your baby is delivered. The test scores will be recorded, and then the test will be completed again five minutes after your baby’s birth. Both scores will be used.

Completing the test twice helps ensure accuracy and it also helps the doctors detect any discrepancies that may have occurred from the first test to the second test. Changes between the scores or two low scores could mean issues, and so the APGAR test helps doctors get your baby assessed right away so that they can deliver appropriate care to your infant.

What Does An APGAR Score Mean?

A score between 7 and 10 is considered normal. A score between 4 and 6 indicates that breathing assistance may be required. A score under 4 means that prompt, life-saving measures may be called for.

To get the overall score for an infant, a score of 0 to 2 will be assigned for each of the 5 aspects medical staff will check.

  • Heart rate: 0 means there is no heart rate, 1 means there are fewer than 100 beats per minute (not very responsive), 2 means there are more than 100 beats per minute (baby is vigorous)
  • Respiration: 0 means there is no breathing, 1 means there is a weak cry, 2 means there is a strong cry
  • Muscle tone: 0 means the baby is limp, 1 means the baby has some flexion, 2 means the baby has active motion
  • Reflex Response: 0 means no response to their airways being stimulated, 1 means there is a grimace during stimulation, and 2 means there is a grimace and cough/sneeze during stimulation
  • Color: 0 means the baby's entire body is blue/pale, 1 means the baby has good color except on their hands/feet, 2 means the baby is completely pink and has good color

It's important to keep in mind that an infant rarely has a perfect score. Medical staff will communicate with you if both APGAR tests come back with a low score or if they have a reason for concern.

What Causes a Low APGAR Score?

If your baby has a low APGAR score, which is defined as 6 or below, they may have signs such as a slow heart rate or no heart rate, weak breathing or no breathing, little flexion or no muscle tone, little to no response to stimulation, and little to no color, which means poor blood flow or circulation.

These signs are obviously cause for concern, and medical staff will respond accordingly. The causes of these signs can vary, but the most common causes of these signs include:

  • Oxygen Deprivation: This means that your baby’s brain is not getting enough oxygen or, in some cases, may be completely deprived of it. Brain damage can result depending on the extent and length of deprivation your baby has experienced.
  • HIE: When a baby's brain is deprived of oxygen, their brain cells can become injured. If your baby is suffering from HIE, medical staff may proceed with infant cooling, which is a multiple-day process that will slow down and prevent damage to their brain cells.
  • Cerebral Palsy: Treatment is out there for cerebral palsy, which is a condition affecting your baby's physical abilities. This congenital condition can last anywhere from a few years to a lifetime. It can be inherited through genes.

These causes have different treatment options, responses, and effects on your baby’s long-term well being.

What Happens If My Baby Has A Low APGAR Score?

If your baby has a low APGAR score, medical staff will first focus on getting your baby into a stable condition and then they will seek to find answers to the questions that will be weighing on your mind, like what has caused your baby’s low score.

As medical staff works to discover if there is an underlying condition or another cause of your baby's low score, they will keep you updated throughout the process. More importantly, they will keep you informed about your baby's current state of health and what to expect in the coming days.

What Is An Assisted APGAR Score?

Up to 10% of newborns who are delivered in a hospital require assistance with their breathing for a brief period of time after they are delivered. While this can certainly be concerning to see as a parent, it is not necessarily an indication of your baby’s overall condition or future health.

Medical staff will offer assistance to your baby as needed based on the results of their APGAR tests. If they have reason to believe that there are further complications or an underlying condition, they will treat your baby appropriately and inform you of that notion.

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