Sunday, July 20, 2014

APGAR score in practice and its implications


A baby is born. Pediatrician receives the delivery, fetal bradycardia with maternal hypertension was the scenario. Baby is efficiently resuscitated. By the time everything is settled its around 7-8 minutes of babies life. In such a rush scenario, APGAR now has to be awarded retrospectively. A skilled pediatrician or neonatologist can do good but still it has a drawback. 

The Apgar scoring system was intended as an evaluative measure of a newborn's condition at birth and of the need for immediate attention.

In practice
We often use mnemonic form APGAR, for our convenience. But in fact the mnemonic does not represent the initials for true parameters we use for evaluation.
Example Pulse is not used in newborn for assessment, instead Heart rate is used, but P in APGAR stands for pulse rate.

The real parameters are given Below-


What we use in practice for convenience-

Though the assessment may not be much different in practice, it makes a big difference when using such parameters in exams.

Importance of APGAR
1.Despite the advent of modern technology, the Apgar score remains the best tool for the identification of newly born infants in need for cardiopulmonary resuscitation.
2. Data suggest that serial Apgar ratings in infants with early low scores detect clinically important recovery of lack thereof.


Drawbacks of APGAR 
1. Subjective assessment
2. Retrospective assessment - usually done after resuscitation so health workers usually recall after the event.


Few Interesting Readings-
The Apgar scoring system was intended as an evaluative measure of a newborn's condition at birth and of the need for immediate attention. In the most recent past, individuals have unsuccessfully attempted to link Apgar scores with long-term developmental outcomes. This practice is not appropriate, as the Apgar score is currently defined. Expectant parents need to be aware of the limitations of the Apgar score and its appropriate uses
J Perinat Educ. 2000 Summer; 9(3): 5 Apgar Scores: Examining the Long-term Significance Kristen S. Montgomery, PhD, RNC, IBCLC 

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