When I visit a new mum for the first time in the postnatal period, I often experience the following: I am proudly presented with the baby and told that the newborn scored 9-10-10 on the Apgar test immediately after birth in the delivery room. It could hardly be better! But then - "...er, what exactly was that again? Apgar test is something to do with breathing ... or pulse ...?" And where does the name actually come from? "I bet there used to be a 'Mr Apgar'," joked a father recently.
Mothers and fathers are familiar with the term Apgar test resp. Apgar Score After all, the results of this first examination of your baby immediately after birth are recorded in the maternity record and in the child's yellow examination booklet. Nevertheless, you may also be interested to know what the Apgar test is all about and what exactly is behind the scores.
So: the namesake "Mr Apgar" assumed by the dad was actually a "Mrs Apgar". Because this examination goes back to Virginia Apgar (1909 -1974), an American surgeon and anaesthetist. In 1952, the doctor developed a scheme and scoring system according to which newborn babies are examined immediately after birth. The aim is to gain an initial impression of the child's state of health by examining certain bodily functions. Here Virginia Apgar was inspired by anaesthesia, where patients are also monitored using this method.
The inventor of the Apgar Test has specified the following for newborn babies: The baby receives 0 to 2 points for each of the five defined characteristics, depending on its current state of health. This "check" is carried out three times in quick succession: one minute, five minutes and ten minutes after birth. The child can therefore achieve a maximum of 10 points per examination.
What is analysed in the Agpar test?
As a kind of mnemonic device, the initial letters of the five bodily functions being analysed form the term APGAR:
Atmung of the baby
This assesses how much effort the newborn has to make to breathe or how regularly it breathes: if it doesn't breathe at all, it scores zero points. Slow or irregular breathing is awarded one point. Two points are awarded for regular breathing or vigorous crying.
Puls
The pulse indicates the heart rate. Zero points means that the pulse is not perceptible. If the heart rate is less than 100 beats per minute, the child receives one point. More than 100 beats per minute is awarded two points.
Ground tone
This refers to muscle movement or muscle tension. This includes, for example, grimaces that the baby makes or the movement of arms and/or legs. If the muscle tension is limp or the baby shows no movement, zero points are awarded. One point is awarded for sluggish muscle movements and two points for vigorous movements.
Asee
This is about the baby's skin colour. A pale to bluish colour is awarded zero points. If the little body is pink, but the arms and legs are still slightly bluish, this means one point. Two points are awarded for evenly rosy skin over the entire body.
Reflexes of the baby
Tests are also carried out to determine how well reflexes can be triggered in the newborn by certain stimuli. These include the grasping reflex, where the baby closes its fingers around something (e.g. the midwife's finger) that touches its palms. If there are no reflexes, this means zero points. If the baby shows only slight reactions, one point is awarded. If the baby reacts immediately, it receives two points.
With this examination scheme, Virginia Apgar has made it possible to record and compare the vital signs of newborn babies according to standardised criteria. This is not about "performance tables", but solely about vital questions: How is the child doing immediately after birth? Can it adapt to the new living conditions outside the womb on its own - or does it possibly need support, e.g. to breathe on its own? Is urgent medical treatment perhaps even required?
In this sense, the Apgar test has probably already saved the lives of many newborn babies. It was also introduced in Europe at the beginning of the 1960s and is carried out by the midwife or doctor present at the birth.
What does the result of the Agpar test say?
The values of the Abgar test therefore show a snapshot of the child's state of health immediately after birth. At Premature babies however, they are only of limited use or not at all. This is because, depending on the week of pregnancy in which the tiny babies are born, they are usually not yet fully mature.
But even if your baby was born on time, you may be worried because it didn't score the full 10 on the Apgar test. However, I can reassure you: Only very few newborns get the maximum score of three times 10 points anyway. Because most of them still have a slightly bluish tinge to their skin during the first examination one minute after birth, for example, one point is deducted for this reason alone. And even if the mother was given painkillers during labour, the baby's Apgar score may be slightly lower.
Most children score at least seven points at the first test time (one minute after birth). Then they are doing well. In many children, the Apgar scores increase because the baby has already completed a considerable amount of adaptation after five or ten minutes. Results such as 7-8-9 or 8-9-9 or 7-9-10 are not uncommon. Such an upward development of points shows that the child does not need any support and is coping well on its own. Incidentally, the following applies: Newborns can take their time with the adaptation, as long as the Apgar values are in the "green range" on the third test run.
The situation may be different for values below seven points.
The Apgar test in detail:
9-10 points:
The baby is doing excellently. Its condition is described by the obstetricians as "optimal and fresh". If necessary, only mucus or amniotic fluid is aspirated from the baby.
7-8 points:
In the professional definition, the child is considered "normally alive": it shows clear vital functions and is in a good state of health.
5-6 points:
At these values, obstetrics speak of a "mild state of depression". The child may now need a little "jump-start" so that its breathing, reflexes and circulation become more vital. In any case, more intensive monitoring is advisable.
3-4 points:
These values are technically referred to as "moderate depression". This degree of adjustment disorder often leads to support for the child, for example in the form of short-term oxygen administration via a breathing mask. This should help the baby to breathe on its own and develop rosy skin. The child may also be placed in a heated bed.
0-2 points:
The baby is in a critical condition. These Apgar scores are referred to as "severe depression". This means that life-saving measures such as artificial respiration, cardiac massage or medication - or a combination of these - are required immediately.
The Apgar test is the first examination in your child's life and part of the so-called U1. This takes place in the first 30 minutes of the baby's life and includes further examinations.
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