VII.

Pediatric Additions to Health Assessment

1. APGAR Scoring
A score is given for each sign at one minute and five minutes after the birth. If there are
problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered
normal, while 4-7 might require some resuscitative measures, and a baby with Apgar of 3 and
below requires immediate resuscitation.
 A baby’s first test
 Quick assessment of the newborn’s overall well-being
 Given one-minute after birth and five minutes after birth
 Rates 5 vital areas

What Does "Apgar" Mean?

Apgar stands for "Appearance, Pulse, Grimace, Activity, and Respiration."
In the test, five things are used to check a baby's health. Each is scored on a scale of 0 to 2,
with 2 being the best score:
 Appearance (skin color)
 Pulse (heart rate)
 Grimace response (reflexes)
 Activity (muscle tone)
 Respiration (breathing rate and effort
How is the Apgar score done?
The Apgar score is a number calculated by scoring the heart rate, respiratory effort, muscle
tone, skin color, and reflex irritability (response to a catheter in the nostril). Each of these
objective signs can receive 0, 1, or 2 points.
What does a high or low Apgar score mean?
A perfect Apgar score of 10 means an infant is in the best possible condition. An infant with
an Apgar score of 0-3 needs immediate resuscitation. It is important to note that diligent care
of the newborn is an immediate response to the current status of the infant. It is inappropriate
to wait until Apgar scores are obtained to begin or continue to address the needs of the neonate.
When is the Apgar scoring done?
The Apgar score is done routinely 60 seconds after the birth of the infant and then is repeated
five minutes after birth. In the event of a difficult resuscitation, the Apgar score may be done
again at 10, 15, and 20 minutes.
What does a persistently low Apgar score mean?
The persistence of low (0-3) Apgar scores at 20 minutes of age is predictive of high rates of
morbidity (disease) and mortality (death).
Why was the Apgar score developed?
The score is named for the preeminent American anesthesiologist Dr. Virginia Apgar (1909-
1974), who invented the scoring method in 1952. Having assisted at thousands of deliveries,
Dr. Apgar wished to focus attention on the baby. Babies were traditionally dispatched directly
to the nursery, often without much formal scrutiny after delivery. Apgar wanted the baby to be
assessed in an organized meaningful manner by the delivery- room personnel. Dr. Apgar was
the first woman to be appointed a full professor at Columbia University's College of Physicians
and Surgeons.

Online References:
https://kidshealth.org/en/parents/apgar.html
https://www.slideshare.net/charmainegraceedep5/apgar-scoring-for-newborns
Textbook Reference:
Lynn S Bickley; Peter G Szilagyi; Richard M Hoffman (2017). Bates' Guide to Physical
Examination and History Taking. 12th Edition. Philadelphia : Wolters Kluwer