apgar score by abhishek jaguessar

8/4/2019 Apgar Score by Abhishek Jaguessar

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BY ABHISHEK JAGUESSAR


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APGAR EXPANSION

A for Appearance

P for Pulse Rate

G for Grimace

A for Activity

R for Respiration


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From Current Researches in Anesthesia and Analgesia,July-August, 1953, page 260.

Presented before the Twenty-Seventh Annual Congressof Anesthetists, Joint Meeting of the InternationalAnesthesia Research Society and the InternationalCollege of Anesthetists, Virginia Beach, Virginia,

September 22-25, 1952.


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23/25th Sept 1952


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A Proposal for a New Method ofEvaluation of the Newborn Infant

Virginia Apgar, MD, New York, NYDepartment of Anesthesiology,

Columbia University,

College of Physicians & Surgeons andthe Anesthesia Service,The Presbyterian Hospital


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The first page of the original Apgar

paper

http://www.neonatology.org/classics/apgar2.html
http://www.neonatology.org/classics/apgar2.html


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Grading"of newborn infants which canbe used as a basis for discussion and

comparison of the results of obstetricpractices, types of maternal pain relief andthe effects of resuscitation


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"score"

"breathing time"defined as the time fromdelivery of the head to the first respiration.

"crying time"the time until the establishment

of a satisfactory cry.


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Cry

A satisfactory cry is sometimes notestablished even when the infant leaves

the delivery room, and in some patientswith cerebral injury, the baby dieswithout ever having uttered asatisfactory cry. Mild, moderate andsevere depression of the infant leaves afair margin for individual interpretation.


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The time for judging thefive objective signs weresixty secondsafter the

complete birth of the baby


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1) Heart Rate

A heart rate of 100-140 was considered good and givena score of two, a rate of under 100 received a scoreof one, and if no heart beat could be seen, felt orheard the score was zero.

If one attends the baby alone, it is easy to learn to lookbriefly at the epigastrium or precordium for visibleheart beat.

Palpation of the cord about two inches from the umbilicusis the most satisfactory method for determining theheart rate quickly and avoids the area of clamping ortying of the cord.


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It is of greatassistanceto the person

caring for the baby to have an assistantdemonstrate by motion of a finger ofone hand the heart rate as palpated by

the other hand.

In only three cases was a heart rate of

over 140 detected, accompanied byarrhythmia in two of these infants.


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2)Respiratory Effort

An infant who was apneic at 60 seconds after birthreceived a score of zero, while one who breathed andcried lustily received a two rating. All other types of

respiratory effort, such as irregular, shallow ventilationwere scored one.

An infant who had gasped once at thirty or forty-fiveseconds after birth, and who then became apneic,

received a zero score, since he was apneic at the timedecided upon for evaluation.


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3) Reflex Irritability

This term refers to response to some form

of stimulation. The usual testing methodwas suctioning the oropharynx and nareswith a soft rubber catheter which called

forth a response of facial grimaces,sneezing or coughing.

Although spontaneous micturition and

defecation are not a response to an appliedstimulus, they were considered to be

favorable signs if they occurred.


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4) Muscle Tone

A completely flaccid infant received a zero score,and one with good tone, and spontaneously flexedarms and legs which resisted extension wererated two points.


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5) Color

All infants are obviously cyanotic at birthbecause of their high capacity for carryingoxygen and their relatively low oxygen content

and saturation.

The disappearance of cyanosis dependsdirectly on two signs previously considered --respiratory effort and heart rate. Comparativelyfew infants were given a full score of two forthis sign, and many received zero in spite oftheir excellent score for other signs.


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A score of two was given only whenthe entire child was pink.

Several hundred children were rated at three orfive minutes as well as at sixty seconds and inalmost all cases a score of two could be given forcolor at these later times.

This finding agrees well with the heel bloodoxygen studies in 402 infants, conducted atSloane Hospital during 1947-48.

In an occasional instance the color was worse atfive minutes than at sixty seconds. and thesecases were therefore missed with our usual

method of evaluation.


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It has been most gratifying to notethe enthusiastic interest andcompetitive spirit displayed by theobstetric house staff who took great

pride in a baby with a high score.The same trend of interest has beennoted in another hospital which has

undertaken the ratings of babies inthis manner.


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Material

During the period of this report (sevenand one-half months) 2096 infantswere born in the Sloane Hospital forWomen. Eighty-four per cent of theanesthesia records of these births areon file. The missing 16 per cent are

chiefly those with pudendal blocks or"natural childbirth" patients.


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Type of Delivery and Score

No. ofInfants Score

Low forceps orspontaneous

843 8.4

Cesarean section 141 6.8

Midforceps

delivery

17 6.9

Breech delivery 16 6.7

Version and

breech extraction

4 6.3


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Cesarean Sections -- The cesarean section rate at

Sloane Hospital is 10.5 per cent during this period. Theanesthesia methods for the 141 rated infants born bycesarean section are listed:

Infants Average Score

Spinalanesthesia

83 8.0

Generalanesthesia 54 5.0

Epidural orcaudal

4 6.3


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Infants who have been subjected to a trialof labor are in better condition than thosein whom cesarean section was chosenelectively

Infants Average Score

Patients in labor 57 7.1

Patients not in labor 84 6.7


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There were 16 cases of breech deliveries excluding

twins and version and breech extraction. All butone who precipitated without anesthesia wereanesthetized with general anesthesia in a plane aslight as compatible with the obstetric maneuvers.Nitrous oxide, ethylene or cyclopropane were usedfor this purpose. The average score was 6.7,essentially the same as for cesarean sectioninfants.


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Infant AverageScore

Twins, generalanesthesia

14 8.2

Twins, regionalanesthesia

4 9.8


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23/25th Sept 1952


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Thus, the prognosis of an infant is excellent if he receives one ofthe upper three scores, and poor if one of the lowest 3 scores.From this we may also conclude that color as a sign is relativelyunimportant when observed one minute after birth.

Score Infants Deaths in thisgroup

0, 1 or 2 65 9 or 14%

3, 4, 5, 6 or 7 182 2 or 1.1%

8, 9 or 10 772 1 or 0.13%


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A practical method of evaluation of thecondition of the newborn infant one minuteafter birth has been described.

A rating of ten points described the bestpossible condition with two points eachgiven for respiratory effort, reflex irritability,muscle tone, heart rate and color.


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apgar score by abhishek jaguessar

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