APGAR score and Ballard score

K. C. JANAK
Apgar score

 The Apgar score is a test given to newborns soon after birth. This test checks
a baby's skin color, heart rate, muscle tone, reflexes, breathing to see if extra
medical care or emergency care is needed.

 The test is usually given twice: once at 1 minute after birth, and again at 5
minutes after birth. Sometimes, if there are concerns about the baby's
condition, the test may be given again at 10 minutes.
What Does "APGAR" Mean?
Apgar stands for "Appearance, Pulse, Grimace, Activity, and Respiration."
 In the test, five things are used to check a baby's health. Each is scored on a
scale of 0 to 2, with 2 being the best score:
1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)
What Does Baby's Score Mean?
 A baby who scores a 7 or above on the test is considered in good health.
 A lower score does not mean that baby is unhealthy. It means that baby may
need some immediate medical care, such as suctioning of the airways or
oxygen to help him or her breathe better.
 Perfectly healthy babies sometimes have a lower-than-usual score, especially
in the first few minutes after birth.
 A slightly low score (especially at 1 minute) is common, especially in babies
born:
• after a high-risk pregnancy
• through a C-section
• after a complicated labor and delivery prematurely
The Neonatal Resuscitation Program guidelines state that the Apgar score
is:
 useful for conveying information about the newborn’s overall status and
response to resuscitation.
 However, resuscitation must be initiated before the 1-minute score is
assigned. Therefore, the Apgar score is not used to determine the need
for initial resuscitation, what resuscitation steps are necessary, or when
to use them.
 An Apgar score that remains 0 beyond 10 minutes of age may, however,
be useful in determining whether continued resuscitative efforts are
indicated because very few infants with an Apgar score of 0 at 10
minutes have been reported to survive with a normal neurologic
outcome.
 it states that “if we can confirm that no heart rate has been detectable
for at least 10 minutes, discontinuation of resuscitative efforts may be
appropriate”.
 5-minute Apgar score of 7–10 as reassuring, a score of 4–6 as moderately
abnormal, and a score of 0–3 as low in the term infant and late-preterm
infant .
 That document considers an Apgar score of 0–3 at 5 minutes or more as a
nonspecific sign of illness, which “may be one of the first indications of
encephalopathy”. However, a persistently low Apgar score alone is not a
specific indicator for intrapartum compromise.
 There are numerous factors that can influence the Apgar score, including:
a. maternal sedation or anesthesia,
b. congenital malformations,
c. gestational age,
d. trauma, and inter observer variability.
 The score also may be affected by variations in normal transition.
 For example, lower initial oxygen saturations in the first few minutes need
not prompt immediate supplemental oxygen administration; the Neonatal
Resuscitation Program targets for oxygen saturation are 60–65% at 1 minute
and 80–85% at 5 minutes.
 The healthy preterm infant with no evidence of asphyxia may receive a low
score only because of immaturity.
Ballard score
 Tool for estimating newborn gestational age by rating physical and
neuromuscular characteristics of maturity.
 For infantsborn between 20 and 28 weeks' gestation, Ballard tools are more acc
urate than other systems of estimating gestational age.
 Six neuromuscular markers are assessed: posture, square window (degree of
wrist flexion), arm recoil, popliteal angle(degree of knee flexion); scarf sign (abili
ty to extend infant's arm across the chest past the midline); and heel-to-ear
extension.
 Seven physical characteristics are also evaluated: skin; lanugo; plantar creases
breast; eye and ear; and genitals.
Each factor is scored independently, and then an overall sum is used to determi
ne the gestational age.
 most accurate if performed within the first 12 to 20 hr of life or as soon as
 the baby's condition stabilizes.