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Why do some babies have lower Apgar scores than others? What are the hidden reasons behind this?
The Apgar score is a quick assessment of a newborn's health, performed by medical professionals one and five minutes after birth. The scoring system was created in 1952 by Columbia University anesthesiologist Virginia Apgar to address the lack of standardized methods for assessing the needs of newborns at the time.
The Apgar score is assessed using five criteria: activity (muscle tone), pulse, facial expression, appearance, and respiration. The score range for each criterion is 0 to 2.
The history of the Apgar score comes from Apgar's development of newborn assessment criteria, which was officially published in 1953. Although the purpose of this scoring system is to quickly diagnose whether a newborn baby needs immediate medical assistance, the score is not intended to predict long-term health problems in the newborn baby.
Interpretation of Apgar Scores
Different members of the health care team, including midwives, nurses, and doctors, may be involved in the Apgar assessment of your newborn. Scoring at one and five minutes is the most common practice. If the score is low, it may be re-evaluated at a later date.
Generally speaking, a score of seven or above is normal; four to six is low; and three or below is considered a danger indicator that requires immediate medical intervention.
Many factors may cause a baby to have a low Apgar score, including the circumstances of the birth and the mother's health. While low Apgar scores in the short term may indicate a need for medical intervention, they do not necessarily mean long-term health problems, especially if the five-minute scores improve.
Implementation of the Apgar Score
In situations where a newborn requires emergency resuscitation, health care providers will begin resuscitation procedures before the one-minute Apgar score. Therefore, the Apgar score should not be used to decide whether to start resuscitation, but rather to assess whether resuscitative measures need to be continued.
If the five-minute Apgar score is less than seven, the physician should reassess the score every five minutes until 20 minutes have passed, according to the neonatal resuscitation program guidelines.
Although the Apgar score is an important assessment indicator, it may not accurately reflect the true condition of the newborn during resuscitation. Because resuscitation measures may inflate scores and affect the accuracy of assessment results. For this reason, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend the use of an expanded Apgar report to document the resuscitation method used at each time point.
Limitations of the Apgar Score
The Apgar score takes into account many subjective factors, such as skin color, muscle tone, and reflex stimulation. These subjective assessments may vary between different healthcare providers. The study showed that differences in Apgar scores between whites and non-whites could unnecessarily affect a baby's subsequent medical management.
Non-white babies tend to have lower Apgar scores than white babies, which could lead to them receiving unnecessary medical attention in the future, according to a 2023 study.
In the process of neonatal care, the subjectivity of scoring criteria and the consistency of scores among medical workers are important issues that need to be improved. Some studies have shown that the agreement between healthcare providers on Apgar scores ranges from only 55% to 82%.
These observations make us think whether it is necessary to review and improve this scoring standard in order to better serve the health of every newborn?
