From the Guidelines
Newborn depression based on Apgar scores refers to a condition where a newborn shows signs of poor adaptation to extrauterine life, typically indicated by an Apgar score below 7. The Apgar scoring system evaluates five parameters:
- Appearance (skin color)
- Pulse (heart rate)
- Grimace (reflex irritability)
- Activity (muscle tone)
- Respiration, with each component scored 0-2 for a total possible score of 10. Scores are typically assessed at one and five minutes after birth. A score of 7-10 indicates a normal newborn, 4-6 suggests moderate depression requiring some resuscitative measures, and 0-3 indicates severe depression requiring immediate and extensive resuscitation. The one-minute score reflects the immediate need for resuscitation, while the five-minute score better correlates with long-term outcomes. If a baby has a low Apgar score at five minutes, additional scores may be recorded at 10,15, and 20 minutes. This scoring system helps healthcare providers quickly assess a newborn's condition and determine appropriate interventions, though it's essential to note that Apgar scores alone don't predict long-term neurological outcomes and should be considered alongside other clinical indicators 1. The Apgar score is a valuable tool for assessing newborn health, but it should be used in conjunction with other clinical assessments to determine the best course of care. It's also important to consider that Apgar scores can be influenced by various factors, including gestational age, maternal medications, and neurologic conditions, as highlighted in the studies 1. Therefore, healthcare providers should be consistent in assigning an Apgar score during resuscitation and use an expanded Apgar score reporting form to account for concurrent resuscitative interventions.
From the Research
Definition of Newborn Depression Based on Apgar Scores
The definition of newborn depression, also known as birth asphyxia, can be understood through the lens of Apgar scores. Apgar scores are a method to quickly assess the health of newborn children immediately after childbirth [ 2, [ 3 ].
Apgar Score Components
The Apgar score is based on five components:
- Appearance (skin color)
- Pulse (heart rate)
- Grimace (reflexes)
- Activity (muscle tone)
- Respiration (breathing rate and effort) [ 2 ].
Low Apgar Scores and Newborn Depression
Low Apgar scores, particularly those less than 7, have been associated with increased risks of neonatal mortality and morbidity [ 2, [ 4 ]. Studies have shown that Apgar scores less than or equal to 3 at 1 and 5 minutes, combined with umbilical artery pH values less than 7.00, can reliably diagnose birth asphyxia [ 5 ].
Factors Associated with Low Apgar Scores
Several factors have been identified as being associated with low Apgar scores, including:
- Fetal birth weight less than 2.5 kg
- Skin incision to delivery time
- Pregnancy-induced hypertension
- Antepartum hemorrhage
- General anesthesia
- Meconium-stained amniotic fluid
- Emergency cesarean section [ 2 ].
Association with Neurologic Disability
Low Apgar scores have also been linked to an increased risk of neurologic disability, including cerebral palsy, epilepsy, and cognitive impairment [ 4 ]. However, the absolute risks are low, and most surviving babies with low Apgar scores grow up without disability.
Clinical Significance
The Apgar score is a routine clinical measure that provides important prognostic information, particularly in critical congenital heart disease [ 6 ]. Understanding the factors associated with low Apgar scores and their implications for newborn health can help identify interventions to improve outcomes.