ACCURATE

A proposal for a new method of evaluation
of the newborn infant.

A SCIENTIFIC EXHIBIT PRES€NTED AT

THE TWENTY-SECOND POSTGRADUATE ASSEMBLY

  IN ANESTHESIOLOGY

NEW YORK HILTON HOTEL

DECEMBER 16, 17 AND 18, 1968

SIGNIFICANCE OF THE APGAR SCORE

As in other pathological conditions, treatment of newborn depression
rests upon accurate diagnosis. The various physical signs are con-
veniently summarized by the Apgar Score. This has little relation to oxy-
genation but does reflect the degree of acidosis. (Fig. 1) A score from
7-10 generally applies to a "vigorous", 4-6 to a "depressed" and 0-3
to a "markedly depressed" infant. (1) (2) (3).

In addition to the predictive value for survival, there is a relationship
between the Score and the development of neuromuscular deficits in
childhood. Fig. (2-3)

i,Ul '* YlRUTES

Fig. 1 Comparison of vigorous and depressed
APGAR SCORE to acidosis. (5)

1

b-

f

eL Y L1

0-123454789

SCORE

Percentage oi Z7day oemtsi mortality within each score at 1 and 5 minutes.

infants relating

Fig. 2 Apgar Scores and outcome of newborn. (3)

Fig. 3 Percentage of neurological ab9ormality at 1 year, by 1 and 5
minutes score, by birth weight and by combination of birth weight and
5 minutes score. (3)

"Nine months observation of the mother surely warrants one
      minute observation of the baby"

V. Apgar

SIGN

TECHNIQUE OF "SCORING"

0 1 2

A) Observations are made exactly at one, five, and ten minutes after

delivery of the entire infant.

REFLEX
IRRITABILITY

COLOR

B) The modalities listed are obtained according to the table below

and appropriate values assigned.

GRIMACE CRY

  NO
RESPONSE

BLUE BODY PINK      COMPLETELY
PALE EXTREMETIES BLUE      PINK

1 RESPIRATORY SLOW GOOD

EFFORT I ABSENT 1 IRREGULAR I CRYING 1

I

ACTIVE

I OF EXTREMITIES I MOTION 1

FLACCID

MUSCLE

I TONE

C) In order to be consistent, and to gain the full advantage of proper
treatment and prognosis, it is imperative that scores be recorded
in their proper time sequence.

The "APGAR SCORE TIMING UNIT" (shown below) has made
such temporal accuracy possible.

APGAR SCORE SHEET

PITFALLS AND PROBLEMS

1. Subjectivity of persons involved in delivery.
2. Making tabulation at accurate time intervals.
3. Difficulty of monitoring heart beat when working alone.
4. Respiratory effort may be difficult to assess.
5. Cyanosis may persist peripherally in many "healthy" infants.

SUGGESTED EQUIPMENT FOR INFANT CARE AND

RESUSCITATION IN THE DELIVERY ROOM

1. Timer and APGAR SCORE sheet
2. Laryngoscope
3. Airways
4. Cole endotracheal tubes of various sizes
5. Suction
6. Infant warmer with thermostat
7. Oxygen - both positive pressure and flow
8. Umbilical vessel canula
9. Sodium Bicarbonate ampoules

10. Epinephrine ampoules

REFERENCES:

1. A proposal for a new method of evaluation of the newborn in-

fant.

V. Apgar-Anesth. Analg. 32:260. 1953

V. Apgar - Pediatrics Clinics of North America - 645, 1966

J. S. Drage, M.D., H. Berendes, M.D.

Pediatrics Clinics of North America - 635, 1966

B. Smith, M.D., F. Moya, M.D.-Anesth; 26:552, 1965

James, S. L. Bull. Sloane Hosp. Wom. 5:107, 1959

2. The newborn (APGAR) scoring system

3. Apgar scores and outcome of the newborn

4. Resuscitation of the depressed baby.

5. Pattern of recovery of buffer base in the first hour of life.

David J. Hammer, M.D.
Raymond Portu, M.D.
Arthur Santiago, M.D.

Miguel A. Colon-Morales, M.D.

Jewish Hospital and Medical
Center of Brooklyn
Teachers Hospital
Hato Rey, Puerto Rico

"Apgar Score Timer Unit"O and "Apgar Score Pad"O
Developed by the Department of Anaesthesiology
  Teachers Hospital, Hato Rey, Puerto Rico

supplied by

RESUSCITATION LABS@

P.O. Box 3051, Bridgeport, Conn. 06605