Updated: 12/30/2021

APGAR Scores

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  • .Snapshot
    • A 30-year-old G2P1 woman at 39 weeks of gestation is in active labor. She undergoes a vaginal delivery and gives birth to a baby boy. The baby is vigorously dried and he begins to cry. At 1 minute after delivery, the baby is crying, he has a pink body and but somewhat grey extremities, and his pulse is 130/min. He is moving all 4 limbs and grimaces in response to nasal suction. The nurse calculates an APGAR score of 8. At 5 minutes after delivery, the nurse notes that the baby continues to show good breathing with intermittent crying, is now pink all over, and his pulse is 134/min. The baby coughs and pulls away in response to nasal suction and continues to move all 4 extremities with good tone. The nurse calculates a new APGAR score of 10. Given the baby's strong APGAR scores, he does not undergo any intervention/resuscitation after the five-minute mark.
  • Introduction
    • Overview
      • a scoring system used to assess the newborn at 1 minute and 5 minutes after delivery
      • 90% of neonates have an APGAR score of 7-10
      • APGAR score < 7 at 5 minutes indicates need for further intervention/resuscitation
    • One Minute designed to assess the neonates status and the uterine environment
    • Five Minute designed to assess the neonates status and adaptation to the external world
    • APGAR Scoring System
      Score012

      Appearance (skin color)

      • Blue body
      • Pink body but blue extremities
      • Body and all extremities are pink
      Pulse
      • Absent
      • < 100/min
      • > 100/min
      Grimace (irritability)
      • No response to nasal suction
      • Grimace response to nasal suction
      • Coughs, sneezes, and pulls away to nasal suction
      Activity (muscle tone)
      • Flaccid
      • Weak muscle tone but some movement
      • Moving 4 limbs with good tone
      Respiration
      • Absent breathing
      • Slow, irregular breathing
      • Good breathing and crying
  • Case Examples
    • 1 MINUTE APGAR: 5
      • A newborn infant at 1 minute has acral cyanosis and weak respiratory effort and respirations are 30/min. Pulse is 105 and a systolic murmur is heard. She has weak reflexes in all 4 extremities only after external stimulation. When her nose and mouth are suctioned there is no response. Her eyes are closed.
      Appearance1
      Pulse2
      Grimace0
      Activity1

      Respiration

      1
    • 1 MINUTE APGAR: 6
      • At 1 minute a newborn's pulse is 90/min, good respiratory rate (crying), pink body with blue extremities, weak muscle tone with flexion of the extremities, and a facial grimace response to nasal suction but no cough/sneeze.
      Appearance1
      Pulse1
      Grimace1
      Activity1
      Respiration2

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(M2.OB.17.4800) A newborn male is evaluated one minute after birth. He was born at 38 weeks gestation to a 28-year-old gravida 3 via vaginal delivery. The patient’s mother received sporadic prenatal care, and the pregnancy was complicated by gestational diabetes. The amniotic fluid was clear. The patient’s pulse is 70/min, and his breathing is irregular with a slow, weak cry. He whimpers in response to a soft pinch on the thigh, and he has moderate muscle tone with some flexion of his extremities. His body is pink and his extremities are blue. The patient is dried with a warm towel and then placed on his back on a flat warmer bed. His mouth and nose are suctioned with a bulb syringe.

Which of the following is the best next step in management?

QID: 109279

Chest compressions and bag-mask ventilation

0%

(0/32)

Intravenous epinephrine and reassessment of Apgar score at 5 minutes

3%

(1/32)

Positive pressure ventilation and reassessment of Apgar score at 5 minutes

59%

(19/32)

Supplemental oxygen via nasal cannula and reassessment of Apgar score at 5 minutes

31%

(10/32)

Endotracheal intubation and mechanical ventilation

6%

(2/32)

M 7 D

Select Answer to see Preferred Response

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