The Apgar test is a medical test done in the first moments of the baby’s life, which serves to see her general condition after delivery and does not cause discomfort for him. This immediacy makes it possible to detect problems that require prompt attention. The Apgar test measures five parameters that score between 0 and 2 and whose maximum score will be 10.
The Apgar test is a physical examination in which a series of physical parameters are observed that are evaluated in two moments: at one minute after birth and at five minutes, hence it has two different values.
The name is derived from Dr. Apgar, who was the one who developed this test in 1953. Since then, she has managed to save the lives of many babies and prevent situations that could pose a problem in the following hours.
What is the Apgar test?
The Apgar test is a physical examination in which a series of physical parameters are evaluated in two moments: one minute after birth and five minutes; hence it has two different values.
The usual thing is that the score of a baby without problems is between 8 and 10 in the first minute; if it is below this value, the baby will be stimulated by rubbing with a towel, and if necessary, oxygen will be provided in the first moments. With these two simple maneuvers, the baby will have an Apgar of 8/10 in the next 5 minutes.
The parameters to assess are heart rate, respiration per minute, muscle tone, reflexes, and skin color. All of them score from 0 to 2, depending on how the baby is doing.
Numerous texts on neonatology and pediatrics refer to the Apgar test to identify an NB who requires resuscitation. However, the current recommendation of the AAP and American Academy of Cardiology is to identify the NB who requires resuscitation by answering five questions that are: The clear or meconium-free liquid? Is the NB crying or breathing? Does the NB have a good muscle tone? Is the NB pink? Is it a term NB? These questions then begin with the initial stages of resuscitation, that is, the newborn is positioned with the neck slightly extended, the secretions from the mouth are aspirated, and after the nose, it is dried, repositioned, stimulated, and provided oxygen. Subsequently, the heart rate, respiratory effort, and color are simultaneously evaluated. Until now, no more than 30 seconds should pass since the RN was born. But resuscitation is not started according to the Apgar score; only some vitality indicator elements are used23,24. The Apgar score is assigned to the minute, and resuscitation must always begin before the minute of life. It is further recommended that at each birth, especially if it is risky, there should be a person skilled in carrying out a complete resuscitation and another person capable of assisting in resuscitation. The first minutes of a newborn’s life can be critical; it is when the child is transitioning from intrauterine to extrauterine life, and how it is treated may depend on the quality of life of him and his family. Each NB has the right to be treated at the highest level of competence and in an efficient and timely manner; his assistance must be immediate, the resuscitation of a depressed NB cannot wait, the delay can lead to sequelae, and irreparable damage. The Apgar at 5 min can be a good indicator of the effectiveness of resuscitation maneuvers.
The definition of asphyxia suggested by the AAP has sparked controversy and discussions among clinicians. Goodwin19 refers to this and says that the evaluation of a depressed newborn due to asphyxia should be based on objective findings such as the history of altered fetal records, umbilical artery gases, neurological compromise. Using these base points together with a follow-up, the diagnosis can be clarified.
But not only has the Apgar test been used as an indicator of asphyxia, but it has also been used as an indicator of neonatal survival, and perhaps this is one of the most exciting points. Davis25 analyzes the survival prognosis in extremely low-weight newborns concerning their condition at birth and the need for resuscitation. All high-risk NBs are cared for by a neonatologist. None survived of 62 newborns who weighed between 501 and 750 g, those who needed positive pressure ventilation, cardiac massage, and medications at birth. When analyzing according to the Apgar test, it was found that NBs between 501 and 750 g with Apgars between 0 and 3 per minute did not survive; however, NBs who had Apgars above 6 per minute had a survival of 75%. According to the Apgar test, the group of children with greater weight showed a significant difference in survival, finding a survival of 89% for NBs with Apgar> 6 versus 38% when the score was <3. The Hospital Clínico de The Catholic University of Chile26 in a total of 12,274 NBs found mortality of 93.3% for NBs with Apgar of 1 at 5 min and a mortality of 50% for NBs with Apgar <3 at 5 min. Casey27, in a recent publication, analyzes whether the initial Apgar test is capable of predicting survival 50 years after its application. This study was conducted at Parkland Hospital in Dallas, a tertiary-level center of the University of Texas. 145,627 NBs> 26 weeks were studied, products of single deliveries between January and December 1998. In all NBs, umbilical artery pH and Apgar score were taken at 1 minute and 5 min. The incidence of neonatal deaths among preterm infants with Apgars between 0 and 3 at 5 min was 315 per 1,000 versus 5 per 1,000 if the NB had an Apgar score greater than 7. The average Apgar score was related to gestational age At 5 min; however, the incidence of neonatal deaths was higher for children with a score of <3 regardless of gestational age. For example, at 26 and 27 weeks, the neonatal death rate was 385 per 1,000 for children with Apgars between 0 to 3 compared to 147 per 1,000 live births (VN) for those with Apgars between 4 and 6 of the same age. When analyzing the incidence of neonatal deaths in term newborns with Apgar at 5 min from 0 to 3, it was 244 per 1,000 NV, while for those with Apgar> seven, it was 0.2 per 1,000 NV.
At 39 and 40 weeks, the neonatal death rate was 189 per 1,000 NV among children with scores between 0 to 3 compared to 12 per 1.0 00 among children with Apgars between 4 to 6 and 0.1 per 1,000 for those with an Apgar> 7.
Apgar at 5 min was a better predictor of neonatal survival than pH measurement even with severe acidemia. However, for both preterm and term NBs, the combination of Apgar <3 and pH <7.0 increased the risk of death. Regarding the time of deaths, a poor condition at birth, reflected in a low Apgar score (0-3) at 5 min, was significantly associated with early neonatal death at any gestational age.