Explanation of newborn indicators

In modern medicine They use the Apgar scale to assess the health of the child immediately after birth.

This technique was developed in 1952 Virginia Apgar from America, who was an anesthesiologist by profession. It turned out to be so universal and easy to use that the scale is still used all over the world, with the only difference being that in some countries it has a different name (adapted to the local language).

The Apgar score is immediately announced to the child’s parents, along with such important indicators as weight and height.

In the abbreviation of the word APGAR, each letter has its own meaning:

• Appearance – skin color, Pulse – child’s pulse, Grimace – grimace, facial movements;
• Activity – the activity of the movements performed, Respiration – breathing.

This system implies making two assessments, from 0 to 10 points. The first assessment is made within the first minute of the child’s life, the second – after five minutes.

As a rule, the second score exceeds the first by 1-2 points, since the newborn child already has time to “get comfortable” a little.

Points are awarded for mandatory assessment following criteria(where 0 is the minimum value, 1 point is the average value, and 2 points is the high value):

1. Work of the heart. A neonatologist determines the pulse rate per minute, for this the number of beats in 6 seconds is multiplied by 10. The pulse of newborn babies is more frequent than that of an adult, and is normally about 120-140 beats per minute. The highest score of 2 points is given when the number of beats is 100 per minute or more, 1 point - less than 100 beats, and 0 points - in the absence of cardiac activity, or with single contractions of the heart (in this case, urgent resuscitation is required).
2. Breath. The number of breaths in a newborn baby varies between 40-45 per minute. If the first breath was accompanied by a loud cry, the baby will receive a score of 2 points, if at birth the cry was weak, more like a groan - 1 point, if there is no cry and weak respiratory activity - 0 points.
3. Muscle activity. Usually, at birth, children make active movements with their arms and legs, for which they receive 2 points. If muscle activity is weak - 1 point, absent - 0 points.
4. Presence/absence of reflexes. Already from birth, a little person has such reflexes as breathing, sucking, swallowing, etc. This criterion implies an assessment of their presence.
5. Skin, color. During a visual examination, the skin and mucous membranes are assessed. Their color should range from light pink to “reddish”. If there is cyanosis - 1 point, general pallor and pronounced cyanosis - 0 points (this may indicate hypoxia or the presence of pathology).

After evaluating all criteria, it displays total score, in practice it never reaches 10 points in the first seconds of life (no more than 15% of newborns receive such a rating).

After five minutes a re-assessment is carried out. If necessary, the child’s condition is assessed several times, every five minutes.

A good indicator is the following values: 8/8, 8/9, 9/9, 9/10, 10/10. In this case, everything is fine with the child, and he is transferred to his mother’s care.

With indicators of 5/7, 6/7, 7/8, the child’s life is not in danger, there are no visible pathologies, but the newborn requires increased attention.

With values ​​of 4/5, 5/6, 6/6, observation by medical personnel is required for at least 5 days, and assistance, if necessary.

If the newborn’s Apgar health score is 4/4 points or less, then the condition is regarded as severe and often requires medical intervention and a number of procedures and resuscitation.

U premature babies who were born ahead of schedule, a health rating of 5/7 is already considered good.

Surprisingly, those babies who were born through a cesarean section usually have a fairly high Apgar score, from 8/8 and above. Perhaps this is due to the fact that these children did not go through a difficult and difficult birth path.

Based on all of the above, a health score on the Apgar scale of 8/8 points is good indicator, and there is no reason to worry. After all, as you know, young mothers worry about any reason, and it is better for them to take care of their nerves and health for the sake of the child.

Today, this score of 8/8 points is the most common. This system for assessing the health of a newborn is quick and was created with the goal of identifying the child’s need for urgent resuscitation care. It was created for doctors, and does not affect the child’s health in the future life.

It is now customary to use the Apgar score of newborns in a table to determine the condition of the child. How relevant is the use of this technique in the modern world? Should these first grades given to the baby be taken into account?

Criteria for evaluation

More than 60 years ago, a doctor from America, Virginia Apgar, proposed determining the condition of a child in the first minutes of birth using 5 indicators. She included in the list:

• the depth and strength of the baby's breathing;
• heart rate;
• muscle tone of the body;
• innate reflexes;
• appearance of the skin.

Each of them received from 0 to 2 points, according to the scale she developed. The total figure, first of all, should have been of interest to obstetricians. And serve as a signal for the start of resuscitation procedures.

How many points can you score on the scale and how are they deciphered?

The maximum number on the Apgar scale for newborns is 10. But it is placed extremely rarely; only a few of the babies born fully satisfy all its requirements. The most common indicator: 8 points on the Apgar scale.

	0 (absent)	1 (weak)	2 (bright)
Breath	No breathing movements	Slow and labored, a quiet moan	More than 40 respiratory movements per minute, loud cry
Heartbeat	No pulse wave	Less than 100 beats/min. (probability )	Greater than or equal to 100 beats/min.
Muscle tone of the body	Body movements are completely absent, and arms and legs hang down	The arms and legs are slightly bent at the joints, the movements themselves are sluggish and slow	The head is pressed to the chest, the hands are clenched into fists and bent at the elbows; active and chaotic movements
Reflexes (tested by inserting a catheter into the nasal cavity)	No reaction	The child reacts with a slight grimace or movement	The child reacts by moving, coughing, sneezing and screaming
Appearance of the skin	Equally pale or bluish color throughout the baby	Pale pink body color with bluish extremities	Pale or bright pink uniform color of body and limbs

All points received are summed up and the result is interpreted.

A newborn baby is given Apgar scores several times: in the first seconds of his life; In 5 minutes; after 10 minutes to understand its condition in dynamics.

Normally, the second grade received should be 1 or 2 points higher. Here are examples of decoding the Apgar scale:

Total points	Decoding
10/10	The baby's indicators are above normal
8/9, 9/9, 9/10	The baby's condition is normal
8/8	The baby's performance is above average
6/7, 7/8, 7/7	The baby does not need additional supervision
5/6, 5/5, 4/5, 4/4	The baby's condition requires additional and thorough monitoring.
3/3, 3/4	The newborn is in critical condition
0/0, 0/1, 1/1, ½, 2/2, 2/3	The baby needs urgent resuscitation

Don’t be afraid of the words - resuscitation procedures, when assessing a newborn on the Apgar scale of 4 or 6. By this, doctors mean more thoroughly clearing the baby’s airways, warming him with a lamp and providing him with additional oxygen.

In addition to weight and height, these obtained Apgar scores at birth are also recorded in the medical card.

What should be the norms for height and weight of newborns, see.

Did you have a premature baby? Don’t be upset, because in a year he will be no different from his peers who were born on time.

Gradually, the child grows, gains weight, and what he should be able to do at 3 months, we will tell you in the article.

When will a newborn's fontanel close? together, is there an exact time frame?

Objectivity of the points received

The assessment of the baby's indicators, which is carried out using the newborn Apgar score in the table, is subjective. It is carried out visually by a pediatrician, based on his experience.

Of course, the difference between 4 and 9 is significant, but between high numbers it is almost unnoticeable. Therefore, having received the result, a young mother has no reason to be upset if the child feels great, even with a score of 7 or 8 on the Apgar scale immediately after birth.

It is impossible to say that a newborn with an Apgar score of 9/9 will definitely be stronger than a child with lower scores. It just means that the first one screamed harder, or had more pronounced reflexes. And another could have signs of cyanosis due to a longer stay without oxygen during prolonged labor.

Don’t worry about your baby if he was given a “low” rating; this does not reflect the full picture of his health.

All these numbers are simply a signal for obstetricians and neonatologists, which indicates the volume of activities that should be carried out in the delivery room and the beginning of resuscitation procedures.

Over time, additional research will be carried out. Such as:

• and urine;
• tests for the presence of intrauterine infections;

Based on the results obtained, a plan will be developed for the follow-up and treatment of the newborn.

A child's Apgar score has nothing to do with the overall health of the baby, much less mental abilities.

Comments from doctors on the use of the Apgar score

Safronova N.Yu., Moscow, City Clinical Hospital No. 24, neonatologist

I think the use of this method is necessary, especially in the very first minutes of birth. This helps not to get confused and clearly understand further tactics of procedures and manipulations.

This is especially necessary for novice doctors with little experience.

On my own behalf, I can also add that, according to my observations, “caesareans” almost always have Apgar scores with a decoding of 8/9. This is due to the fact that they did not experience stress or hypoxia while passing through the birth canal.

Therefore, some expectant mothers want to lie on the operating table for the sake of a good assessment. This should not be done without medical indications.

Chueshova I.V., Vitebsk, Educational Institution "VODKTs", pediatrician

After being discharged from the maternity hospital, the babies come to see me, and in their statements I always pay attention to the points they received.

I can say with confidence that children with an Apgar score of 7/7 are absolutely no different from children with a higher score.

They all get sick equally often, and their general health depends only on the attitude of their parents towards it.

Gogul L.V., Samara, Maternity Hospital No. 2, obstetrician-gynecologist

Each birth is complex in its own way, and it is impossible to foresee everything in advance and know the result for sure. Sometimes everything happens according to the textbook, and as a result, a wonderful, healthy child is born, then everything is clear without ratings on the scale.

And it happens that the birth is difficult and the child does not want to be born. And once born, he is so weak and tired that he requires additional help from us.

Then there is a need to realistically assess the condition of the newborn using the Apgar scale. This simple method, proven over the years, is widely used all over the world due to its convenience.

The Apgar score for newborns is a modern way of assessing the readiness of infants for extrauterine life. The first exam will not affect your love for your baby, but it won’t hurt to learn about the intricacies of passing it and the meaning of the mysterious numbers in the extract from the maternity hospital. Let's talk in more detail about what the Apgar scale is, how to decipher it and what to do if your baby gets low scores.

From this article you will learn

What does this scale mean?

A scale for assessing the health of a newborn based on external signs is necessary for obstetricians-gynecologists and pediatricians present at the birth. Based on the results of the examination and the summation of points, a decision is made on the mandatory provision of emergency resuscitation care to the baby and on the possibility of transferring him to the mother in labor in a shared ward.

The APGAR system was developed in 1952 as a teaching material for students and an aid in the work of nurses. The innovation was given the name of its creator - an anesthesiologist Virginia Apgar, professor. The invention of the rating was required by the increasing number of cases of births of children with intrauterine pathologies and strangulation during childbirth. And it has been successfully used in obstetrics and pediatrics for 70 years.

Apgar scale – score range from 0 to 10 points. The child is examined twice in the first and fifth minutes after birth, and scores are assigned according to 5 indicators:

1. epidermis color– A (Appearance);
2. heart rate– P (Pulse);
3. reflexes, reflex excitability– G (Grimace);
4. muscle tone, motor activity– A (Activity);
5. breathing pattern– R (Respiration).

For each item, the baby receives from 0 to 2 points. After summing up the points, the result on the Apgar scale is ready. If the result of the examination at the fifth minute is 0–7 points, then the assessment is carried out three more times after an equal period of time: at the 10–15–20th minute. Determining the result takes no more than one minute, no additional equipment is required.

In the postpartum discharge, the child has at least 2 indicators on the scale, for example 7/9 or other numbers. This will mean that in the first minute he received 7 points, and in the fifth - 9. To evaluate the result positively, it is important to see the dynamics of adaptation (the first numbers will be less than the subsequent ones).

Learn more about each option

The condition of the newborn is assessed based on external signs of the body’s vital functions. To understand how this happens, let’s look at each point in more detail.

Obstetricians and pediatricians use the table to quickly obtain results on the Apgar scale. She looks like this ( Attention! The table can be scrolled left and right):

Parameter	0 points	1 point	2 points
Color of the skin	Pale, blue (cyanosis).	The legs and arms are bluish, the rest of the body is pale pink.	The skin tone is even, pink over the entire surface of the body.
Heart rate	Single manifestations, no pulse.	Less than 100 beats per minute.	130–140 beats per minute.
Reflexes	Complete absence.	Lack of expression.	Pronounced swallowing, sucking, grasping.
Muscle tone	No movement.	Body movements are weak and rare.	Chaotically, regularly swings its limbs.
Breath	Absent.	Moans, breathes irregularly (hypoventilation).	Screams, breathes deeply, often.

The result of the assessment is the summation of points for each indicator. This happens as follows:

• Color of the skin

If a newborn has a light pink or hot pink skin tone, it receives 2 points. A bluish tint to the extremities with a normal color of the epidermis of the rest of the body reduces the score to 1 point and signals the doctor about weak fetal hypoxia.

Everywhere the blue color of the skin, excessive pallor is a reason to carry out resuscitation procedures and give 0 points for the first indicator.

This is interesting! By the way, children born through cesarean section more often receive the maximum 2 points for this criterion. This is due to the fact that the natural passage of the birth canal is not easy for the baby and can affect the level of oxygen in the tissues. But the Caesars manage to avoid this.

• Pulse

Heart rate is measured 6 seconds after birth by auscultation, palpation of the chest or palpation of the arteries. Then they multiply the resulting figure by 10, which gives the minute result.

The heart of newborns works actively. The normal pulse rate is between 130 and 140 beats per minute. In this case, the child earns 2 points.

If the heart beats unstably and slowly, the baby receives 1 point; if there is no pulse at all, 0 points.

If the indicators are not normal, then the baby is given resuscitation procedures until the heart rate returns to normal.

• Reflexes

The ability to suck, grab, swallow, and breathe are the first reflexes of newborns necessary for life. If the child clearly shows the presence of these innate skills in the first minutes of life, then he receives a high score of 2 points. The baby should look for the breast, smack his lips, scream after birth, and breathe.

If reflexes are weakly or partially expressed, then he earns 1 point, if they are completely absent - 0 points.

To obtain an objective assessment, obstetricians stimulate manifestations of reflex movements:

• put a finger to the baby’s lips;
• place the newborn on a flat surface, encouraging him to step;
• lay on the tummy and push under the heels, awakening the crawling reflex;
• a catheter is inserted to clear mucus from the baby’s nose; It’s great if the baby sneezes, grimaces, and moves his head away.
• Muscle tone

Chaotic movements of the arms and legs are the main indicator of the baby’s well-being immediately after birth. He strives to straighten his limbs and bring his body to its normal position. This behavior adds 2 points to the total.

The baby gets 1 point if:

• moves weakly, but does it reluctantly;
• arms and legs remain in a bent position.

With a complete absence of body movements, maintaining the fetal position or close to it - 0 points.

• Breath

The baby earns 2 points if he screams piercingly after birth and in the first minute of life maintains a normal breathing rhythm - 40-45 inhalations and exhalations. If, instead of screaming, the newborn moans, wheezes, or breathes unevenly, he will be given 1 point; if there are no manifestations of this criterion, he will be given 0 points.

Important! It is worth considering that premature babies born unnaturally, but through cesarean section, receive lower Apgar test results. Women should not be upset about this and invent shortcomings for the baby. Attention, care and careful care can quickly correct the situation.

What do ratings mean?

In the delivery room, women are usually not given accurate Apgar scores. Parents see the result in the card after discharge home or find out from the doctor. To decipher the results yourself, use the following decoding of the sum of points.

• 0-2 . The newborn is in a critical situation and requires the help of a resuscitator.
• 3-4 . The indicator is satisfactory. Deviations from the norm are average. This result is often obtained by premature babies. After birth, the baby is observed by a pediatrician, obstetrician, and neurologist.
• 5-6 . Satisfactory result, deviations from the norm are small.
• 7-9 . The indicators are optimally positive. Deviations are weak.
• 10 . Healthy child.

To simplify the algorithm for evaluating the results, we give examples of the results of testing of newborns:

• 8/9, 9/9, 9/10

The baby feels wonderful. Doctors and mother do not need to worry about his well-being and closely monitor his condition until discharge from the hospital.

The clinical result is normal. The baby feels good and has adapted to the external environment quickly.

• 7/8, 6/7, 5/7

Perhaps the baby was born a little weakened, but quickly recovered by the fifth minute. She feels well and does not require medical care or close supervision by a pediatrician.

Satisfactory indicator. Urgent medical attention is not needed.

• 6/6, 5/5

The condition is average; pediatricians need to monitor the newborn more closely.

• 4/5, 5/6

The result is below average, but there is a positive trend. The child is observed more closely for 1–2 weeks after discharge.

• 4/4, 3/4

This result requires measurement at the tenth minute after birth. The baby's physical condition is poor. In this case, the woman and child are placed in a hospital for further observations.

• 2/3, 3/3

Resuscitation is needed, the condition is critical.

• 2/2, 1/2

The child shows obvious signs of asphyxia, and there is a threat to the life of the newborn. Pediatricians must provide immediate resuscitation.

• 0/2, 0/1, 1/1

The situation is difficult, the baby is on the verge of life and death. It is impossible to do without resuscitation and a detailed examination.

This is interesting! A score of 10 is given to newborns in Russia extremely rarely. This is due to the mentality of the medical staff, the fear of jinxing things and showing unprofessionalism. Thus, 9 points can correspond to 10, accepted internationally.

What is considered normal

Newborn Apgar assessment is a worldwide method for detecting defects in intrauterine development of infants. In obstetrics, he was loved for his objectivity and simplicity. The sum of points allows you to get a complete clinical picture of the baby’s condition, draw up a plan for observations and postpartum care for him.

Glasses are considered normal indicators of the level of physical and reflex development from 7 to 10. In this case, the baby does not require medical care; it is handed over to the mother in labor and applied to the breast.

• 5–6 - slight deviations;

Rehabilitation takes time; often the deficiencies are temporary. Associated with asphyxia and fetal immaturity.

• 3–4 - general condition is unsatisfactory;

There is an average degree of oxygen starvation of the baby. Resuscitation procedures will be required to bring breathing and pulse to a normal rhythm.

• 0–2 - critical situation;

There is a risk of death of the newborn. First of all, respiratory stimulation (ventilation) is carried out. The reason for low indicators may be low body weight of the baby, prematurity, hypoxia.

The level of manifestation of the Apgar scale criteria is determined twice: in the first and fifth minutes. When indicators are low, it is important to observe positive dynamics. If a child received 4–5 points in the first minute, but 7–9 in the fifth, then he is considered a healthy child. The lack of dynamics is an alarming sign, a reason to take measurements two or three more times and provide the baby with urgent resuscitation care.

It is important to understand that the Apgar test is subjective for the further development of the baby. Kids with a score of 9–7 will not necessarily be smarter or stronger than those who received low scores.

What if the score is low

Early diagnosis of a newborn’s condition is a lifesaver for modern obstetricians. The Apgar rating indicates the level of well-being of the baby in the first minutes of life. Of course, all parents hope for the birth of a healthy, strong baby, which means high marks on the scale.

Low scores indicate the presence of congenital developmental anomalies and poor adaptation of the infant to the external environment. The most common reasons for negative results are:

• Asphyxia – suffocation. Occurs as a result of entanglement of the fetus with the umbilical cord, obstruction of the respiratory tract with mucus and amniotic fluid.
• Hypoxia is a lack of oxygen during the prenatal period. The brain and tissues do not receive enough oxygen. This results in bluish skin, swelling, and low physical activity in the first minute of life.
• Prematurity. Physiological immaturity, insufficient body weight.
• Birth injury. A healthy fetus suffers during the passage of the birth canal.
• Intrauterine infections. Transmitted from mother to fetus.
• Incompatibility of blood between mother and fetus. Risk of Rh conflict.

Asphyxia and hypoxia are considered especially dangerous. Prolonged lack of oxygen leads to serious developmental problems in the child in the future and provokes serious neurological diseases, such as:

• Syndrome of increased reflex and nervous excitability. It persists in children up to 3 months of age. Babies are restless, often cry, and sleep poorly. Decreased or increased muscle tone, trembling of the chin and limbs are recorded.
• Convulsive syndrome. Leads to epilepsy. Characterized by involuntary contraction of one or a group of muscles.
• Comatose syndrome. Consciousness, sensitivity, and motor function are depressed.
• CNS depression. Reflexes are weak, the baby sleeps a lot and eats little.
• Hydrocephalus. Fluid accumulates in the newborn's brain. A delay in physical and mental development is diagnosed.

Birth trauma causes cerebral palsy, VSD, hypertension, and motor impairment. The consequences of intrauterine infection are difficult to predict. These are various diseases of hearing, vision, internal organs, and stillbirth.

Babies with hypoxia or asphyxia are born weak and passive. The Apgar test result is measured two to four times and is no more than 6 points. By organizing proper care, providing professional medical care, and following pediatricians’ recommendations, normalization of the baby’s condition is possible. And the quality of life of the child and parents will depend on this.

Important! Low Apgar test results in premature babies are similar to average in those born on time unless there is serious cause for concern. For example, 6/7 in immature infants is the norm. But regular observations by a neurologist and other specialized specialists will still be required.

Don't be discouraged if your child's Apgar scores are lower than the maximum. After all, everything that is most important for his development will be laid down further - in the first years of life. And a lot will depend on your love and desire to raise your child healthy and happy.

IMPORTANT! *when copying article materials, be sure to indicate an active link to the original

The point system at school is a clear scheme for assessing knowledge according to certain criteria. If we talk about the Apgar score - a system for assessing the health of a newborn, then it is subjective. Compared to school, there is not a wide range of grades. The midwife does them by eye during examination.

In order for expectant mothers to understand exactly how the condition of their child will be assessed after childbirth, we will consider in detail the principle of this scale itself.

How the scale works

What is the Apgar scale and who is its founder? Virginia Apgar, a famous American professor of anesthesiology, introduced a scale for assessing the health status of a newborn child back in the 50s of the last century. The main goal of her method was to promptly identify babies in need of resuscitation measures. Initially, the scale was intended for nursing staff. It was used to determine which child needed more attention.

The technique was named after its founder. Sixty years of experience in using such assessment of a newborn gives reason to believe that the Apgar scale is still quite simple and reliable for a comprehensive assessment. According to many experts, it is a little subjective, because points are given only on the basis of an obstetric examination of the child. The rating scale ranges from 0 to 2 points, where 0 is given for the absence of a certain feature, 1 is given for its average severity, 2 for a well-expressed feature.

Let's look at what exactly is assessed on the scale. It should be noted that for ease of assessment, the English transcription of Mrs. Virginia’s surname was taken. In the word APGAR, each letter stands for a specific evaluation parameter.

• A - activity - activity and muscle tone of the child. A healthy baby has arms and legs pressed to the body, fists clenched. The child is active, moves, his face expresses emotions of peace or dissatisfaction with a cry.
• P - pulse - pulse. The baby's heart rate is normally 130-140 beats per minute. If this indicator in a newborn is more than one hundred beats per minute, then it is given 2 points, less than one hundred - 1 point, the absence of heart rate is recorded as 0 points.
• G - grimace response - the child’s grimaces, the manifestation and degree of expression of the newborn’s unconditioned reflexes.
• A - appearance - skin color and appearance of the child. Shades of pink (from bright to pale) are considered normal. The presence of blueness of the skin, called cyanosis, provides grounds for reducing the score.
• R - respiration - the child’s cry, his breathing, reflex excitability. If a newborn screamed loudly and piercingly immediately after birth, then the score for this parameter is 2 points. A weak cry turning into a squeak, low breathing rate is assessed as 1 point. Lack of breathing and screaming - 0 points.

Assessment results and forecasts

The Apgar scale is used twice to assess the condition of a newborn: in the first and fifth minutes of his life. The first minute assessment shows how the baby experienced the birth. The second assessment indicates the degree of its adaptation to the environment.

Condition results are recorded as a fraction, where the first number represents the first assessment and the second number represents the assessment during the second measurement. It should be emphasized that this scale is not the basis for making further forecasts of the child’s condition and health.

Its results are interpreted as follows:

• 7-10 points - no deviations in health status were identified;
• 5-6 points - minor deviations;
• 3-4 points - significant deviations from the norm;
• 0-2 points - threat to the life of the newborn.

Children with the best results are considered to be in excellent condition and require only routine care. A score of up to 6 points indicates a satisfactory condition and the need for some resuscitation procedures. A child with a score of less than 4 points requires such procedures immediately. If the sum during the second measurement is less than 7, then additional measurements must be taken every 5 minutes. A child who receives 5-6 points on the first measurement and 7-10 on the second goes into the category of healthy children. It should be noted that an Apgar score of 10 is quite rare.

Let us remind you once again about the subjectivity of the Apgar scale and that it is not a method for predicting the development of a baby. Therefore, it cannot be said that a child with a 9-point score will be smarter or healthier than one who received 6 points. The development, health, and abilities of each child are directly proportional to the care, love, and attention of his parents.

Especially for Elena TOLOCHIK

The Apgar score is a universal system for quickly assessing the condition of a newborn. This is the very first check of the child’s health, which is carried out in the first minutes of his life: the first Apgar score is determined 1 minute after birth, the second - 5 minutes later. Thus, the score consists of two numbers (scores) that are assigned by a neonatologist when examining a newborn.

The Apgar rating system allows the doctor to determine whether the newborn needs specialized medical care, resuscitation, increased attention, or whether the child’s health and life are not in danger. In fact, this assessment does not give mom anything, because the Apgar scale is intended for doctors. But every mother wants to know everything about the state of her child’s health and independently figure out what these incomprehensible numbers mean. In this article we will talk about decoding the Apgar scale - what it is and what each specific result means, we will consider all the examples.

This scale was introduced into pediatric practice back in 1952. The developer of a new system for determining the condition of newborns was the American anesthesiologist Virginia Apgar, who proposed several criteria and a scoring system that is assigned by a neonatologist when examining a child. The system consists of 5 criteria, each of which is scored from 0 to 2 points. The sum of points from all 5 criteria determines the condition of the newborn at the current moment and ranges from 0 to 10 points.

Apgar scores

The system includes 5 criteria, each of which is scored from 0 to 2 points in the first and fifth minutes of a child’s life. The more points in total, the better. The best total score is 9 and 10 points.

To assess the condition of a newborn using the Apgar scale, the following indicators are used:

1. Heart rate assessment (pulse) - count the heart rate for 6 seconds, then multiply by 10 to get the pulse per minute. In newborns, the heart works more intensely than in adults, so ideally the result should be 120-140 beats per minute. A score of 2 points is given for a result of more than 100 beats per minute. Score 1 point – less than 100 beats per minute (the need for artificial ventilation is also assessed). If there is no heartbeat or single heartbeats, the score is 0.
2. Breathing assessment – ​​the presence of breathing and its intensity are determined. Normally, a newborn takes 40-45 breaths per minute. A loud, piercing cry of a child immediately after birth is 2 points, slow breathing and a quiet cry or groan after birth is 1, absence of screaming and breathing is 0 points and emergency medical care. With irregular breathing, there is no need to talk about a score of 9/9 or 9/10.
3. Assessment of muscle tone - usually after birth, children actively swing their arms and legs, having gained freedom after a tight position in their mother’s tummy. The child moves actively - this is 2 points, weak movements of the arms and legs - 1 point, lack of movement - 0. In most cases, newborns receive 2 points for the muscle tone indicator.
4. Assessment of reflexes - already at birth, the child has unconditioned reflexes (sucking, swallowing, grasping, etc.), but the most important ones are screaming and inhaling. If the baby screams loudly, breaks out, sneezes or even coughs - this is 2 points, moves poorly and reacts poorly to external stimuli - 1 point, if there are no reflexes - 0.
5. Skin color – the child’s skin color is assessed, paying special attention to the palms, feet, lips and oral mucosa. If the skin color is pink (from light to reddish) it is scored 2 points, if the skin is bluish - 1, if the skin is pale with a bluish tint - 0.

Apgar score table

The evaluation results of all criteria are summed up and the final result is obtained. To simplify, the result of assessing the condition of the newborn can be presented in the form of a table.

Parameter	Points	Grade
Heart rate (pulse)	0	absent
	1	less than 100 beats per minute
	2	more than 100 beats per minute
Breath	0	absent
	1	slow, irregular
	2	normal, loud scream
Muscle tone	0	weak
	1	bends arms and legs
	2	actively moves arms and legs
Reflexes	0	none
	1	weak
	2	the child screams, struggles, sneezes
Color of the skin	0	bluish, pale
	1	pink, but bluish arms and legs
	2	pink all over the body

What do these points mean?

Usually the second score (given at the 5th minute of the child’s life) is 1-2 points higher than the score at the 1st minute - the child has become a little more comfortable and has adapted to his new conditions. In the first minute, a score of 7 on the Apgar scale is characterized as “no visible pathologies,” but 8, 9 or 10 is better. A score of 10 in the 1st minute is extremely rare. At the 5th minute, 8 points on the Apgar scale is considered the maximum norm and the child is handed over to the mother. With indicators of 6/7 and 7/7, doctors conduct an additional control examination every 5 minutes for 20 minutes and look at the dynamics of changes and are ready to help the child at any time (i.e. examinations are carried out on the 5th, 10th, 15th -th, 20th minute of the child’s life).

Newborn Assessment Chart

Result	Meaning
0/2, 1/2, 2/2	the child's condition is extremely serious, threatening the life of the newborn
2/3, 3/3	critical condition 5 minutes after birth, requiring resuscitation or other urgent medical attention
3/4, 4/4	The child’s condition is serious; constant monitoring by doctors is required
4/5, 5/6, 6/6	the indicator is below average, a doctor’s observation is required for at least 5-7 days, medical assistance is required according to the situation
5/7, 6/7, 7/8	the condition is satisfactory, there are no visible pathologies, increased attention is required
8/8	the state is normal, the child is transferred to the mother’s care
8/9, 9/9, 9/10	very good indicator, the child’s health is excellent
10/10	ideal health (not found in practice)

Based on the table data, we draw a simple conclusion: the normal total assessment of the newborn’s condition on the Apgar scale at the 1st minute is 7, 8, 9, 10, at the 5th minute – 8, 9, 10. If your child has indicators of 7/ 8, 8/8, 8/9, 9/9, 9/10 or 10/10, then there is no need to worry, your health is in perfect order.

Results of 5/7, 6/7 and 7/7 are not an indicator of pronounced pathology and do not indicate serious impairment or disability. If there are certain problems, the doctor in the maternity hospital will definitely tell you about it. However, such indicators require increased attention to the child; additional examination may be required.

With a score of 5-6 points, the child needs careful monitoring by doctors, and special treatment measures are often required. After discharge, the child is sent for examination to a neurologist.

If the score is less than 5 points, the condition is assessed as severe, hypoxia occurs, and resuscitation is often required. Such children are transferred to a hospital and are not discharged until their condition improves to a score of 7 on the Apgar scale.

Premature babies usually score lower on the criteria than full-term babies, so a total score of 6 or 7 is a good result for them.

A low final result (up to 5 points) is a cause for concern, but an average Apgar score (5/7, 6/6, 6/7, 7/7) should not lead to panic - such children simply need additional examination by neurologist and other specialists. This indicator is important only in the maternity hospital and for the local pediatrician; in the future it will not affect the assessment of the child’s health status. After all, it is absurd to think that if a child often coughs and sneezes, then this is all because in the 1st minute of life he received only 6 on the Apgar scale in the maternity hospital.

It is clear that every mother wants to hear about a score of 9 or 10 points on this scale, some even begin to envy their roommate in the maternity hospital, whose child was given a higher score. However, there is no need to create a problem where there really is none; it is better to save your strength and nerves for raising your child - you will need them so much.