The APGAR score decides whether or not to resuscitate a new born. This presentation will help one understand the factors that are taken into consideration and how the actual resuscitation procedure is done.

1. PAEDIATRICS AND CHILD HEALTH
• NEONATOLOGY
• APGAR score and Basic Neonatal Resuscitation
Dr. Chongo Shapi (BSc.HB, MBChB, CUZ)
- Medical Doctor.
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2. APGAR score
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3. Introduction
• Dr. Virginia Apgar devised the Apgar score in 1952
• She was American
• It is a tool for assessing the overall status of the
newborn immediately after birth
• It assists in the recognition of an infant who is failing to
make a successful transition to extra-uterine life
• It should be carried out on all babies at one and five
minutes after birth
• Apgar was an anaesthesiologist who developed the
score in order to ascertain the effects of obstetric
anesthesia on babies
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4. • The Apgar scale is determined by evaluating the
newborn baby on 5 simple criteria on a scale from 0
to 2
• Then summing up the five values thus obtained
• The resulting Apgar score ranges from 0 to 10
• The 5 criteria are summarized using words chosen to
form an acronym:
1. Appearance
2. Pulse
3. Grimace
4. Activity
5. Respiration
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5. How Ready Is This Child?
• This is another acronym:
1. Heart rate
2. Respiratory effort
3. Irritability
4. Tone
5. Colour
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6. The 5 Criteria
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8. Interpretation of the scores
• The test is generally done at 1 and 5 minutes after birth
• May be repeated later if the score is and remains low
• Scores:
1. 7 and above are generally normal
2. 4 to 6 fairly low
3. 3 and below are generally regarded as critically low
NB: A low score indicates some degree of birth asphyxia
- Birth asphyxia or hypoxic ischemic encephalopathy
(HIE) that can later develop into long term
neurological damage called cerebral palsy (CP)
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9. Interpretation of the scores
• The purpose of the Apgar test is to determine
quickly whether a newborn needs immediate
medical care
• It was NOT designed to make long-term
predictions on a child's health
• A score of 10 is uncommon due to the
prevalence of transient cyanosis, and is not
substantially different from a score of 9
• Transient cyanosis is common, particularly in
babies born at high altitude
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10. Basic Neonatal Resuscitation
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11. Introduction
• All professionals who attend deliveries must
have basic neonatal resuscitation skills
• High risk situations require a person with
intubation skills to be present at delivery
• 20-30 % of babies requiring resuscitation do
not fall into high risk categories
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12. Deliveries at which a trained neonatal
resuscitator should be present
• Preterm deliveries
• Thick meconium staining of the amniotic fluid
• Significant fetal distress
• Significant APH
• Serious fetal abnormality e.g. hydrops
• Rotational forceps or vacuum deliveries
• Caesarean section
• Multiple deliveries
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13. Resuscitation
Babies fall into one of 3 categories within a minute
of birth
1. Pink, breathing, good tone and activity with a
heart rate of >100 bpm:
▪ Leave this baby alone
▪ Dry the baby, wrap in warm towel and give baby
back to the mother
▪ Do not suck him out – risk producing vagal
bradycardia and cool him
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14. Resuscitation ( cont )
2. Not breathing regularly, but heart rate of > 100
bpm and centrally cyanosed.
▪ Dry the baby wrap, in warm towel and place
under a radiant heat source
▪ Drying often provides stimulation to induce
breathing but gentle rubbing can also be used
▪ If no response begin active resuscitation with
bag and mask and call for help
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15. Resuscitation ( cont )
3. Not breathing or has a heart rate of < 100 bpm
or is pale. These babies are usually completely
floppy
▪ This baby needs prompt resuscitation
▪ Dry, wrap in warm towel and initiate mask
ventilation and call for help
▪ If heart rate remains < 60 bpm, commence
chest compressions
▪ If response not rapid proceed to intubation as
soon as person with necessary skill arrives
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16. Resuscitation ( cont )
The priorities of resuscitation are
1. Clearance of airways
2. Administration of oxygen
3. Maintenance of body temperature
4. Treatment of acidosis
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17. Lung inflation through a face mask
• Position the baby face upwards on a resuscitation
surface
• The head should be supported in a neutral
position to keep the tongue from obstructing the
back of the pharynx
• Gently suction the mouth and nostrils to remove
debris
• Choose a face mask that covers the baby’s mouth
and nose
• Hold mask over baby’s face with one hand using
some of the fingers to lift chin and support jaw
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18. Lung inflation through a face mask
• Begin to ventilate the lungs with air or oxygen
using the source provided
• Never connect a baby directly to the hospital
oxygen or air supply without a suitable pressure
limiting devise in the circuit - babies only need a
pressure of about 30 cm of water
• Make sure the chest is moving with ventilator
breaths
• Give about 30 breaths per minute
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19. Chest compression
• Given to babies whose heart rate fails to rise above 60 bpm
after a minute of effective ventilation
• Compress the lower third of the sternum with two fingers
• The middle and index finger are usually used
• Every third compression should be interposed by a
ventilation – ( 3: 1 ratio ). Thus, per min = 90
compressions and 30 breaths
NB:
- For adult medicine = 30:2, targeting 120 compressions
and 8 breaths in a minute
- A ratio of 15:2 compressions can be used for paediatric
patients
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20. Chest compression ( cont )
• Perform 90 chest compressions and 30
ventilations per minute
• Depress the sternum to a depth of about one
third the A-P diameter of the chest, 2 to 2.5 cm
in a full term infant and 1.5 to 2.0 cm in a
preterm neonate
• When the heart rate is above 60 bpm
compression may be discontinued while
ventilation is continued
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21. Use of drugs during resuscitation
• Drugs are rarely required during neonatal
resuscitation
• Deciding to use them is a job for a skilled
paediatrician
• Occasionally a baby has depressed respiration if
the mother was given pethidine 1 to 6 hours
prior to delivery – Naloxone is an effective
antidote
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22. Transfer to a neonatal special care unit
The following babies usually need further special
care
1. After prolonged resuscitation
2. Birth weight less than 2.5Kg
3. Gestational age less than 36 weeks
4. Persisting respiratory problem
5. Some severe congenital abnormality
6. All ill babies
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23. The End!
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