Role of Apgar scores in Neonatal Resuscitation

The Apgar score is an objective method of evaluating the newborn’s condition. It is generally performed at 1 minute and again at 5 minutes after birth.

• Scores 7 and above are generally normal;
• 4 to 6, fairly low; and
• 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts.

However, resuscitation must be initiated before the 1-minute score is assigned. Therefore, the Apgar score is not used to guide the resuscitation.

At the time of birth, one should ask three questions about the newborn:
i. Term gestation?
ii. Breathing or crying?
iii. Good muscle tone? (flexed posture and active movement of baby denotes good tone)

If answers to all the three questions are 'Yes', the baby does not require any 
active resuscitation and "Routine care" should be provided

If answer to any of the three questions is "No", the baby requires resuscitation.

While the Apgar score is not useful for decision-making at the beginning of resuscitation, the change of score at sequential time points following birth can reflect how well the baby is responding to resuscitative efforts. Hence, Apgar scores should be obtained every 5 minutes for up to 20 minutes, if the 5-minute Apgar score is less than 7.

A low score on the one-minute test may show that the neonate requires medical attention but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy.

Conclusion

Apgar test’s purpose is to determine quickly whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues