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Newborn Apgar test: what is it, when is it done and what is it for?

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When a baby is born, health professionals make several evaluations to know that everything is fine and that it does not require special attention due to any problem during pregnancy or delivery. One of the tools they use to make a quick diagnosis of possible problems is the Apgar scale or test .

Many parents have heard of it, or use those words (“Apgar test”), but they are not very clear what it really is, when it is done or how they do it . Next we are going to talk about the Apgar test and we are going to answer all these possible doubts.

What is the Apgar test

The Apgar test is a first assessment that is made to the baby at birth and that aims to detect possible problems quickly and with little discomfort for the baby. Quick, because if there is a problem, you have to act as soon as possible and it is not very annoying, because if everything is normal it is not necessary to make the baby feel bad at a time of evaluation.

It is called that, Apgar, because it was created by Virginia Apgar, an American doctor specializing in pediatrics and anesthesia, who in 1953 developed this method and published it in order to quickly assess the condition of newborns. Thanks to her, thanks to her test, many babies have saved their lives by being able to detect prematurely any problem that, if not seen, could be fatal a few minutes or hours after delivery.

When and how to do the Apgar test

The Apgar test is done twice, to see the baby’s evolution: one minute after birth and then five minutes later . It is a scale that looks at the baby’s heart rate, breathing, muscle tone, reflexes, and color.

It is not a test or grade that can be used to predict how healthy a baby will be, how strong and big it will be (or not), or anything like that. I say this because on some occasion I have heard mothers comparing their children’s scores (“mine has obtained an 8 in the Apgar test”, “because mine has obtained a 9”), but rather it responds to the state of the baby in the time of evaluation, in how sleepy or awake you are and to see if you are adjusting well to the world you have just arrived in.

The test is divided into 5 sections or questions that score from 0 to 2. Once carried out, the points are added, which in most cases is 8 to 10 points in the first minute of life . If at that time, at that moment, the Apgar is 5 to 7, it is possible that it is due to oxygen supply problems during labor and then the professionals will apply a nearby source of oxygen and probably dry it with a towel relatively vigorously in order to motivate the baby to breathe harder. With both interventions the score should be 8 to 10 at 5 minutes.

Fewer babies score less than 5 (premature babies or those born by emergency cesarean section are more likely to stay at this score), responding to problems during delivery or breathing or heart problems. In this case, the intervention of professionals must be greater, starting with an oxygen mask and, if it is not enough, introducing a tube to make it breathe from the outside and administering the first drugs to improve its heart rate. If this is not enough , the baby is transferred to the intensive care unit to continue with the necessary interventions.

So that you can see what exactly they are looking at, I explain them below:

1. Heart rate : you look with the phonendoscope.

  • If there is no heart rate, it is scored 0.
  • If it is less than 100 beats per minute, score 1.
  • If it is greater than 100 beats per minute, score 2.
  • 2. Breathing:

  • If the baby is not breathing, a score is 0.
  • If you have slow, irregular breathing, score 1.
  • If the breathing is correct, good, or crying, score 2.
  • 3. Muscle tone:

  • If the baby is flabby, such as without muscle tone, the score is 0.
  • If there is some tone and, for example, the limbs flex a little, a 1 is scored.
  • If the baby is actively moving, it is scored 2.
  • 4. Reflexes : it is the response to some relatively annoying external stimulus (touching the soles of the feet, sniffing a little, …).

  • If there is no answer, 0 is scored.
  • If the baby makes faces or gestures, it is scored 1.
  • If there are gesticulations and crying, or coughing or sneezing (in case of using a goatee or catheter to aspirate through the nose), score 2.
  • 5. Skin color:

  • If the baby is bluish or pale, it is scored 0.
  • If the body is pink but the hands and feet are noticeably blue, the score is 1.
  • If the whole baby is pink the score is 2.
  • Once the test is done, as we have already explained, the points are added and based on the score it is decided what to do. Most babies have a maximum score of 9 at one minute of birth , because they all still have very blue hands and feet. At 5 minutes they are more rosy and then, under normal conditions, they score 10. Even many babies who score below 7, with a little stimulation, have a correct score at 5 minutes. If not, the interventions that we have explained above are started.

    Photo | iStock
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