 APGAR Scoring

0 1 2
HEART RATE
>100
Apical pulse (4th- Absent <100 bpm
bpm
5th ICS)
RESPIRATOR
Y EFFORT
Weak cry
rise and fall of Strong/
Complication:
the abdomen; Absent lusty/
congenital heart
babies are loud cry
defects (ASD, PDA)
abdominal
breathers
Some flexion of
extremities
Limp/
MUSCLE Indication: spinal Active
flaccid/
TONE cord injury, spina motion
floppy
bifida
(Meningomyelocele)
REFLEX Cries,
No
IRRITABILITY response
Grimace sneezes,
Rub the back cough
Pale Acrocyanosis normal
(initial) within 24-48 hours
COLOR Pinkish
Cyanotic >2 days: congenital
(late) heart defect

Interpretation
 7-10: normal
 2-6: moderate distress (give oxygen)
 0-3 severe distress (resuscitation)
Resuscitation (S-M-O)
 Suctioning
 Manual ventilation
 Deliver Oxygen

Case Scenario
 1 minute after birth:
 125 bpm - 2
 loud cry – 2 + 2 (respiratory effort and reflex ability)
 active motion - 2
 bluish extremities – 1
 total: 9; interpretation: normal
 99 bpm, weak cry, active motion, bluish nail beds
 99 bpm - 1
 Weak cry – 1 (respiratory effort) + 2 (reflex ability)
 Active motion - 2
 Bluish nail beds – 1
 Total: 7; interpretation: normal
 Cord Cutting
 After the cord pulsation (to prevent anemia)
 Within 3 minutes
 Cord clamp: 1-inch distance from the abdomen
o Clean with 70% alcohol
 Inspect blood vessels (AVA)
o 2 arteries and 1 vein
o Vein: highest oxygen concentration
o Once cut, arteries have the highest oxygen concentration
o 1 A, 1 V: renal agenesis, congenital heart defect

 Proper Identification
 ID tag to prevent switching
 Wrist tag (pink-female; blue-male)
 Routine Newborn Care
 Crede’s prophylaxis (prevention of ophthalmia neonatorum)
o Neisseria gonorrhea
o Chlamydia trachomatis
o Lead to conjunctivitis (sore eyes) that can cause blindness
o Inner to outer canthus/canthi of the lower
conjunctiva/palpebral conjunctiva (upper/vulvar conjunctiva)