The individual scores and total Apgar score are recorded at 1 minute on a special form which should be attached to the infant’s notes. Always record the Apgar score in the infant’s notes. Do not guess the Apgar score as this is usually higher than the correctly assessed score. With practice the Apgar score can be accurately performed in less than a minute.
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The best way to learn how to perform an Apgar score accurately is to score infants with an experienced colleague. The individual scores of the 5 criteria are now added up to give the Apgar score. A score of 0 is given if there is no response to stimulation. However, if the response is poor, a score of 1 is given. If the infant responds well with a cry and movement of the limbs, a score of 2 is given. There is no need to repeatedly flick the feet to assess a response to stimulation. The infant can be stimulated by simply drying with a towel. 1-e Determining the response to stimulation Healthy, normal preterm infants often have poor tone and are given a score of only 1. If the infant is completely limp and does not move at all, a score of 0 is given. With decreased tone the limbs are usually not flexed but lie in an extended position away from the body and resting on the towel. If there is some movement of the limbs but the tone appears decreased, then a score of 1 is given. If the tone and movement appear normal, a score of 2 is given. When lying face up, the arms and feet are moved actively in the air or are held in a flexed position against the body. The normal infant has good muscle tone at delivery. A score of 0 is given if the tongue, hands and feet are all cyanosed. If the tongue is pink but the hands and feet are cyanosed, a score of 1 is given. If the tongue, hands and feet are pink the infant is given a score of 2. Most infants have peripheral cyanosis for the first few minutes after birth. Also look at the infant’s hands and feet for peripheral cyanosis (blue or grey). Do not look at the infant’s lips or mucous membranes of the mouth as their colour is not reliable. The infant’s tongue must be examined to determine the presence or absence of central cyanosis (blue).
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1-c Determining the presence or absence of cyanosis If infants are being ventilated, stop the ventilation for a few seconds to assess any spontaneous respiration. A score of 0 is given if the infant does not make any attempt to breathe.
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If there is poor or irregular breathing, or occasional gasping only, a score of 1 is given.
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If the infant breathes well or cries, a score of 2 is given. Observe the infant’s respiratory movements. A score of 1 is given if the heart rate is less than 100, while a score of 0 is given if no heart beat can be detected. If the heart rate is 100 or more, a score of 2 is given. The normal heart rate is 140 beats per minute with a range of 120 to 160. A wall clock with a second hand is needed in all delivery rooms. Usually the heart rate is counted for 30 seconds and then multiplied by 2, or counted for 15 seconds and multiplied by 4. The femoral, brachial and carotid arteries are difficult to feel immediately after birth. The heart rate can be counted by listening to the heart with a stethoscope, or by feeling the pulsations of the umbilical arteries at the base of the umbilical cord. It consists of scoring the infant’s heart rate, breathing, colour, tone and response to stimulation. The Apgar score determines the infant’s clinical condition after birth.
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When you have completed this skills chapter you should be able to: 1A Skills: Neonatal resuscitation Contents