6. With regard to the Apgar score:
| a. | heart rate < 100 beats per minute scores 0 | False |
| b. | grimace in response to stimulation scores 2 | False |
| c. | flexion of extremities scores 1 | True |
| d. | gasping, weak cry scores 0 | False |
| e. | is normally recorded at 1 and 5 minutes | True |
| f. | active resuscitation is not required unless the 5 minute score is < 5 | False |
| g. | initial ventilatory support should be with a bag and mask at a rate of 10 -20 inflations per minute, with the pressure set at < 30 cm. H2O | False |
| h. | intubation should be performed if the heart rate falls to < 100 beats / minute | False |
| i. | naloxone is safe for babies of opiate addicts | False |
The Apgar score is named after Virginia
Apgar.
Apgar scores are as follows:
|
Feature |
Score = 0 | Score = 1 | Score = 2 |
| Response to stimulation | None | Grimace | Cry |
| Respiration | Absent | Gasping/ weak cry. | Regular/ good cry |
| Heart rate: beats/ minute | 0 | <100 | 100 or more. |
| Trunk colour | White | Blue | Pink. |
| Muscle tone | Limp | Some flexion of the extremities | Active movement / good flexion |
This will be covered on the course, so you will get up to the minute revision of current guidelines.
This topic comes up frequently in the examination.
You need to know the five components of the score and basic resuscitation.
Active resuscitation may be needed immediately if the baby is showing no signs of breathing or has a heart rate <80 b. / minute.
Ventilatory rates are normally set at 20 - 30 per minute.
Intubation should be performed:
if respiration is absent,
or if poor and does not improve with stimulation by two minutes
or the heart rate is <80 b./ minute.
Naloxone may precipitate acute withdrawal symptoms.
The score was devised by Virginia Apgar, a lady with an impressive and varied medical career.
The score was intended to give a reliable and straightforward way to assess a baby’s need for resuscitation.
It remains a basic tool
for this purpose on labour wards more than half a century after its publication.
There has been a lot of interest in the possible link between the score and the risk of cerebral palsy or other neurological damage.
It used to be thought that cerebral palsy was principally due to damage sustained during delivery.
Nowadays, things are more complex and cerebral palsy is thought to be the result of developmental problems in early pregnancy.
But interest remains.
As I write in November 2010, a paper has just been published in the BMJ by Lie et al.
This showed that a low Apgar score in babies born at term and with normal weights indicates an increased risk of cerebral palsy being diagnosed later.
There was a similar, though weaker, link for babies of earlier gestation and lower weights.
But it is a chicken and egg situation.
Are these babies showing low scores as they have reduced “vitality” at birth because of prior developmental problems>
Or are we looking at low Apgar scores as indicators of labour problems that contribute or cause cerebral palsy?
The authors conclude that their results “suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality”.
The article is “open
access” and can be found here:
http://www.bmj.com/content/341/bmj.c4990.full.