Combined apgar score: a new concept 2023

Combined apgar score  is a new concept

APGAR score

APGAR score component

The Apgar scoring system is divided into 5 categories.

Each category receives a score of 0 to 2 points.

Maximum score is 10 and minimum is 0.

Most of babies do not have score of 10  because they have blue hands or feet i.e acrocyanosis immediately after birth.

A: Activity/muscle tone

0 points: limp or floppy

1 point: limbs flexed

2 points: active movement

P: Pulse/heart rate

0 points: absent

1 point: less than 100 beats per minute

2 points: greater than 100 beats per minute

G: Grimace (response to stimulation, such as suctioning the baby’s nose)

0 points: absent

1 point: facial movement/grimace with stimulation

2 points: cough or sneeze, cry and withdrawal of foot with stimulation

A: Appearance (color)

0 points: blue, bluish-gray, or pale all over

1 point: body pink but extremities blue

2 points: pink all over

R: Respiration/breathing

0 points: absent

1 point: irregular, weak crying

2 points: good, strong cry

Total score at 1 min and 5 min after birth is noted .If 5min score is 6 or less,the score is noted at successive 5min intervals until it is >6. A score of 7 to 10 after five minutes is  good.A score of 4 to 6 is moderately abnormal

A score of 0 to 3 is concerning. It indicates a need for assistance in the form of BMV ,CPR

SIGNIFICANCE OF ONE MINUTE APGAR SCORE

It does not correlate with the outcome.Hence it does not guide resuscitationThis score generally correlates with umbilical cord PH and INTRAPARTUM depressions.APGAR SCORE between 0-4 have been shown to have lower PH,high PaCO2 and lower buffer base than those with score >7

COMBINED APGAR SCORE includes

C- CPAP

O- Oxygen

MB- Mask and Bag

I- Intubation

N-Neonatal chest compression

E- Exogenous surfactant

D-Drugs Interpretation

Each intervention is scored 0 if performed and 1 if not performed. This is taken in combination with APGAR score and score <10/17 is an indicator for high morbidity/mortality conclusion combined Apgar score is a valuable assessment tool used to quickly evaluate the overall health and well-being of a newborn immediately after birth. It provides a standardized framework for medical professionals to assess five crucial aspects: heart rate, respiratory effort, muscle tone, reflex response, and color.

By assigning a score to each of these categories at one and five minutes after birth, medical teams can promptly identify and address any immediate concerns or complications the newborn might be experiencing.The combined Apgar score serves as a rapid assessment tool, allowing medical professionals to make quick decisions regarding the need for interventions, such as resuscitation or further medical attention. It’s important to note that while the Apgar score provides valuable information, it is not a definitive diagnostic tool and should be considered alongside other clinical assessments to form a comprehensive understanding of the newborn’s condition.

Over the years, the Apgar score has proven to be a reliable and easily applicable tool in various healthcare settings, aiding in the early identification of newborns at risk of health complications. However, it’s essential to recognize that the Apgar score doesn’t predict long-term outcomes or developmental issues; rather, it offers an immediate snapshot of the newborn’s condition during the critical moments after birth.

Incorporating the combined Apgar score into routine clinical practice contributes to better neonatal care and improved outcomes, as it assists medical teams in making timely and informed decisions. As medical knowledge and technology continue to advance, the Apgar score remains a fundamental tool in the initial assessment of newborns, enhancing the overall quality of neonatal care.

FREQUENTLY ASKED QUESTIONS

Q-Is Apgar score Qualitative or quantitative?It is a qualitative assessment of newborn

Q-What are the 5 components of Apgar?

A: Activity/muscle tone P: Pulse/heart rate G: Grimace A: Appearance (color R: Respiration/breathing

Q-What is a normal Apgar score?

A score of 7 to 10 after five minutes is  good

Q-What is the management for a newborn with a low Apgar score?

A score of 4 to 6 is moderately abnormal.A score of 0 to 3 is concerning. It indicates a need for assistance in the form of BMV ,CPR