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# The newborn and points on a scale Apgar: the most important figures

B the American anesthesiologist Virginia Apgar on the congress of anesthesiologists officially presented to 1952 system of an assessment of a condition of the newborn the first minutes of life. Since then the state of health of the newborn is estimated on five indicators: to breath, heartbeat, muscular tone, reflexes and color of integuments.

## Calculation of points

of the Newborn baby is examined and appropriate 0, 1 or 2 points on each of signs. The assessment in 2 points in the delivery room is considered the highest and means that the sign is expressed to brightly , 1 point - is expressed to poorly , 0 points - a sign are absent . At the best combination of circumstances the joint account of points is equal to 10. Calculation of points carry out twice : in the first and fifth minute of life. Therefore estimates on Apgar always two, for example, 8 / 9 points. Very seldom babies gain 10 points the first minute of life.

the Condition of children who gather result from 7 to 10 points is considered

good or excellent, and they usually need only usual leaving. Those who gained from 4 to 6 points are in a satisfactory condition, and they can are need only some resuscitation procedures. Immediate reanimation is necessary for rescue of life for those whose result lower than 4.

If the baby in the first minute of life are estimated on by 4 - 6 points, to it airways clean more carefully, place under a lamp with radiant heat for additional warming, provide additional supply of oxygen.

## Indicators for an assessment of a condition of the newborn

Now we will dwell upon those signs on which there is an assessment of the baby on 1 - y and 5 - y, and at bad indicators - and upon 10 - y to minute of life.

Work of heart. At the newborn the heart fights very often, making to 130 - 140 beats per minute . Therefore the frequency of serdtsebiyeniye over 100 in a minute is estimated at 2 points. If the kid suffered a shortage of oxygen of the pre-natal period or at the time of delivery, then along with change of other indicators it has a heartbeat delay. Respectively, pulse less than 100 beats per minute is estimated at 1 point, lack of a pulse wave - 0 points.

breath Frequency. the Kid can make to 40 - 45 respiratory movements in a minute , that is takes a breath - an exhalation nearly an every second. Besides, the baby loudly reports to the world about the emergence. It is estimated to the maximum - at 2 points. If the newborn`s voice reminds groan more, but not a victorious call if its breath slow, complicated and irregular, then the child gets 1 point. Lack of respiratory movements and shout - 0 points.

Muscular tone. Normal at all newborns raised by a tone of muscles - sgibately . For this reason they are in a certain pose: the head is given to a breast, brushes are squeezed in cams, hands are bent in elbow, and legs - in knee and coxofemoral joints, in situation on one side the head is thrown slightly back. At the same time the movements of the kid are superfluous, neskoordinirovanna, are chaotic. He can jerk legs and swing handles at all not in a harmony - nevertheless, just such behavior deserves the highest point. If extremities of the child are only slightly bent, and the movements - sluggish and rare, for it 1 point is put. Lack of active movements and a weak muscular tone - 0 points.

Reflexes. the Major unconditioned reflexes begin to function at children directly after the birth. The first shout and the first breath are reflex. Sosatelny and glotatelny reflexes allow the baby to be saturated with maternal milk. Most of all parents strike reflexes of walking and crawling: the baby is put on a tummy, pushed under patches, and just been born kid overcomes distance in several tens centimeters; and put (with support under mice) on a plain surface, it as if executes command “step out!“ . If all these congenital reflexes are shown fully, the little man definitely deserves 2 next points. If reflexes are shown uncertainly even after motivation, more than 1 he will not receive. And their total absence does not bring points at all.

Colour of integuments. Colour of integuments at the newborn varies from faintly - to brightly - pink that is estimated at 2 points. Whites of the eyes, color of mucous membranes of a mouth, lip, palm and the lower surfaces of feet are examined by babies with other skin color (for example, mulattos). The children who were born by Cesarean section most often do not experience difficulties when passing patrimonial ways therefore color of their skin is usually best of all and they gain 2 points on this sign. If the kid has a cyanosis handles and legs, then 1 point is put. At evenly pale or cyanotic color of integuments 0 points are put.

 of 0 points 1 point 2 points Pulse Is absent Less than 100 ud. / min. More than 100 ud. / min. Breath Is absent Slow, irregular Good, shout the Muscular tone Weak Bends handles and legs Actively moves Reflexes Is absent are Poorly expressed Are caused Skin color Cyanotic, pale Normal, but cyanotic handles and legs Normal on all body

## Objective subjectivity

in principle, this assessment in spite of the fact that it is exposed on quite objective indicators, is very subjective for the forecast of future condition of an organism of the child. It is unambiguous to tell that the kid to whom delivered 10 points on a scale Apgar is healthier than the one who got only 7 points, it is impossible. It means only that in the first case the newborn normally breathes, it has pink integuments and mucous, he rather loudly shouts, it well expressed reflexes. And in the second case one or two signs are expressed less brightly: for example, the baby could cry not too loudly or have symptoms of cyanosis (cyanosis of skin).

the Results received by the kid at the birth on a scale Apgar look approximately as follows:

 Points Result of 10 - 7 It is optimum, the norm Easy deviations in a state of health of 3 - 4 Average deviations in a state of health of 0 - 2 Strong deviations in a state of health

the Low mark on this scale can be connected by of 5 - 6 as with a one-stage situation at the birth (a sharp hypoxia or asphyxia), and with a chronic state the baby (a chronic hypoxia), and also his general physiological immaturity (for example, in case of prematurity).

the Most frequent reason of a low mark on a scale Apgar becomes a hypoxia - the pathological state connected with oxygen insufficiency of the child during pregnancy and in labor. Less often at a low mark on a scale Apgar at the child signs of physiological immaturity come to light: slackness, passivity, the lowered muscular tone, suspicious tranquility of the kid who does not react to a dirty diaper long sleeps and seldom demands to eat.

the Scale called subsequently by last name the doctor who made it, Virginia Apgar developed for nurses that those could define quickly what kid should pay special attention.

At a low mark on a scale Apgar on 1 - y to minute of life of the kid is extremely important positive dynamics - an increase of 2 and more points to 5 - y to minute of life. In this case with high probability it is possible to speak about the favorable forecast. The child with a low mark requires special attention of doctors not only in maternity hospital: perhaps, it will need a certain treatment and the subsequent medical supervision from the local pediatrician.

the Assessment on a scale Apgar - both low and high is not the diagnosis, not a sentence and not the press of marriage or the quality mark on the child. It is a signal for the obstetrician and a neonatolog of the volume of the held events in the patrimonial hall and need of reanimation. After that additional examinations are conducted: clinical blood tests, urine, research on pre-natal infections, by ultrasonography - diagnostics, a neyrosonografiya - is also developed the plan of the subsequent medical supervision, treatment and rehabilitation.