If suctioning is needed to clear the airway, a bulb syringe works well. Once the infant is delivered, and the umbilical cord is clamped and cut, the infant is dried. This will also provide the receiving hospital the opportunity to prepare for the newborn. 8 A prehospital APGAR score offers the receiving hospital a consistent and vital assessment of the newborn. With scores less than 7, the APGAR scoring should be every five minutes until the infant is stabilized. If scores are less than 7, the appropriate resuscitation actions should be taken or continued. 2, 6ĪPGAR scores between 7 and 10 are considered normal. Generally, higher APGAR scores will correlate with an infant in better condition. The score offers providers a consistent method to determine the overall status of the newborn. The APGAR score is taken at both one minute and five minute intervals post delivery and is considered the standard in newborn evaluation.
Resuscitation decisions should be based on the clinical triad of respiration, heart rate, and color. 5 Some may require resuscitation, which should be immediately done and not delayed by the getting an APGAR score. Generally, most newborns only require basic interventions such as suctioning, drying, stimulation, and perhaps supplemental oxygen. It is estimated that between 5-10 percent of newborns require some degree of active resuscitation at birth (stimulation to breathe) and 1-10 percent of newborns delivered in the hospital require assisted ventilations. These changes can occur when the infant is most vulnerable and may potentially die or be severely compromised. Butterfield led a 10-year campaign that persuaded the Postal Service to issue a commemorative stamp in her honor.Īfter birth, the newborn infant's body must change to adapt to life outside the womb. He wrote an article 27 years later describing his mnemonic. Apgar thought of the mnemonic (or epigram) as clever but when she contacted his hospital, no one there was aware that "APGAR" was an actual person but rather thought it was a scoring system. Interestingly, in correspondence between Drs. His "APGAR" was the learning aid to recall Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Joseph Butterfield developed the mnemonic APGAR as a way to recall the five criteria of the scoring and used it in his hospital. As many health care providers began to develop their own set of mnemonics to remember the vast number of facts, Dr. Rather, it was referred to as many things, depending on the facility that delivered the infant. Interestingly, the term "APGAR score" was non-existent for 10 years. 3 The first scoring was only done at one minute post delivery, and later done at both the one and five minute post delivery timeframe. It was during this time that she developed the concept of a rating scale of 10 points describing the best possible condition, scoring two points each for each criteria of respiratory effort, reflex irritability, muscle tone, heart rate and color. Apgar reviewed the births of 2096 infants born in the Sloane Hospital for Women. Over a seven-and-a-half month time frame, Dr. Apgar was an anesthesiologist and pediatrician who sought a consistent method to evaluate newborn infants. Virginia Apgar in 1952 and introduced in 1953. It also allows consistent documentation of the newborn's condition at critical times of one and five minutes after delivery. This assessment is easy to do, takes little time, and is consistent between health care providers. The APGAR score is a widely used, standard method to assess a newborn infant. 1, 2 This article will not be discussing neonatal resuscitation, but rather the APGAR scoring. Instead, resuscitation decisions are based on the clinical triad of respiration, heart rate, and color. It should be noted that the decision to begin resuscitation should not be delayed until an APGAR score is obtained.
This article will discuss the APGAR scoring for a newborn assessment. Most EMS agencies can expect to deliver a baby in the field at some time or another.
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