Apgar Score

Apgar score

The Apgar score is a simple assessment of how a baby is doing at birth, which helps determine whether your newborn is ready to meet the world without additional medical assistance. Your practitioner will do this quick evaluation one minute and five minutes after your baby is born.

The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother's womb.

In rare cases, the test will be done 10 minutes after birth.

This score – developed in 1952 by anesthesiologist Virginia Apgar and now used in modern hospitals worldwide.

What Does the Apgar Score Mean?

Apgar is an acronym, standing for the following criteria:

• Appearance
• Pulse (heart rate)
• Grimace (reflexes)
• Activity (muscle tone)
• Respiration (breathing effort)

A pediatrician, ob-gyn, midwife or nurse will assign your newborn an Apgar score from 0 to 2 on each of the five criteria, with a total of 10 possible points. The higher the Apgar score, the better your baby is doing.

Appearance / (Skin color)

• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.

Pulse / (Heart Rate)

Heart rate is evaluated by stethoscope. This is the most important assessment:

• If there is no heartbeat, the infant scores 0 for heart rate.
• If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
• If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

Grimace (reflexes)

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores 0 for reflex irritability.
• If there is grimacing, the infant scores 1 for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

Activity (muscle tone)

• If muscles are loose and floppy, the infant scores 0 for muscle tone.
• If there is some muscle tone, the infant scores 1.
• If there is active motion, the infant scores 2 for muscle tone.

Respiration (breathing effort)

• If the infant is not breathing, the respiratory score is 0.
• If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
• If the infant cries well, the respiratory score is 2.

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Well Newborn Care

Well Newborn Care

Delivery Room Care

* Place the infant skin to skin with the mother, once he is stable.
* Assess the Apgar score, at 1 and 5 min after birth.
* Perform a brief physical examination to check that the infant is
   healthy (has no major anomalies or birth injuries, his/her tongue &
   body appear pink, and has normal breathing).
* Examine the hips to rule out dislocation.
* Umbilical cord care.
         ► Fix the cord clamp 3-5 cm away from the umbilicus, and cut the
                cord using a scalpel.
         ► Examine for any abnormality (single umbilical artery).
         ► Wipe the umbilical stump with ethyl alcohol 70%.
* Identification: take footprints and record in the medical record,
   and place 2 bracelets with identical hospital numbers (one on the
    wrist and the other on the ankle).

Transitional Care (first 4-6 hrs after birth)

* Common signs of disordered transitioning
         ► Respiratory distress
         ► Poor perfusion with cyanosis or pallor
         ► Need for supplemental oxygen
         ► Hypothermia
* Evaluate every 30-60 min
         ► Assess HR, RR, axillary temperature, color & tone.
* With suspicion of disordered transitioning
         ► If stable → observe closely for a period of time.
         ► If persistent signs → transfer to a higher level of care.

Routine Care

* Keep newborn with mother all the time (rooming-in).
* Perform proper hand washing before handling the newborn.
* Maintain newborn’s temperature
        ► Encourage skin to skin contact with the mother
        ► Use hats and proper clothes
* Assess GA using the expanded Ballard Score. Measure and
   record the newborn's weight, head circumference, and length,
   and then plot against the estimated GA.
* Bathing
        ► Do not bathe immediately after birth; vernix caseosa does not
             need to be removed.
        ► The first bath can be given with non-medicated soap and
             warm tap water once infant's temperature has stabilized (4-6
             hrs after delivery).
        ► Do not bathe the infant in a basin until after the umbilical
             stump has fallen off.
* Examine skin for trauma or signs of infection.
* Umbilical cord care
        ► Keep the cord dry and loosely covered with clean sterile gauze.
        ► Fold the diaper below the umbilicus.
        ► If soiled, wash with soap and clean water and dry it well.
        ► Apply alcohol after each diaper change.
* Place the newborn infant supine (on the back) to sleep and not
   prone (on the stomach).
* Routine medications
         ► Give vitamin K1 (0.5-1 mg IM) within 2 hrs of life.
* Feedings
         ► Support immediate and exclusive breastfeeding during the
              first hr postpartum preferably in the Delivery Room.
         ► Offer standard term formula to infants for whom breastfeeding
              is contraindicated at least every 3-4 hrs.

Instructions to the Mothers or Other Care-Givers

* Observe baby’s temperature, respiration & effort at feeding.
* Observe for passage of urine and stools.

Vaccination

* Educate parents about vaccination schedule.
* Administer HBIG (0.5 ml/kg IM) to all newborns of HBsAg positive
   mothers as soon as possible after birth (within 12 hrs),
   followed by HBV vaccine (0.5 ml IM).

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Caring for life...

Can you wake up a Section officer at mid night to sign a document?

Can you wake up a clerk at mid night to prepare a bill?

Can you wake up a lecturer at mid night to teach you?

Can you wake up a shopkeeper to buy a match box from his shop?

Everybody will answer No

But you can wake up a NURSE from a deep sleep at mid night for a patient who suffering in pain,

We the Nurse stand at the bedside of patients to save them because we feel the pain inside us.

                          PROUD 2 B A NURSE

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