The American Academy of Pediatrics Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice published jointly a policy statement on the use of Apgar scores recently in the journal Pediatrics. The policy revises the 2006 statement by AAP and addresses the inappropriate use of Apgar scores to predict health outcomes in individual infants.
Apgar Overview
The Apgar scoring system was created by Dr. Virginia Apgar in 1952 as a standardized method to quickly assess newborn infants. The 10 point score has 5 elements: color, heart rate, reflexes, muscle tone and respiration with each element receiving a score of 0 – 2. Newborns are assessed at 1 and 5 minutes after birth with infants receiving a score lower than 7 being reassessed at 5 minute intervals until 20 minutes of age. Apgar scores at 5 minutes between 7 and 10 points is considered “reassuring”, between 4 and 6 “moderately abnormal” and lower scores “low” according to ACOG and AAP.
Apgar scores are described in the new policy statement as “an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if it is needed.” Apgar scores are also used as important data in research to evaluate how newborns are impacted by a variety of prenatal and birth factors including the mother’s health, prenatal care, birth interventions, birth location (i.e. hospital, home, water) and type of care provider.
AAP/ACOG Policy Statement on The Apgar Score – Summary
The 2015 policy statement replaces the 2006 joint statement from ACOG and AAP and provides 4 recommendations:
1. The Apgar score should not be used to predict outcomes for individual infants.
2. The Apgar score alone is not an appropriate method to diagnose asphyxia or deprivation of oxygen. The policy statement notes that additional information is necessary for this diagnosis.
3. Blood gas samples from the umbilical cord should be obtained when an infant has an Apgar score of 5 or less at 5 minutes of age.
4. To support consistent assignment of Apgar scores during resuscitation efforts, an expanded Apgar score reporting form is encouraged. This form is provided in the policy statement.
Why should doulas know about this new policy statement
While doulas do not assess newborns, of course, staying up-to-date on how tools like the Apgar assessment are to be used and what the scores mean (and don’t mean) is important information to share with clients.
While the Apgar score is considered a standard method of assessment, the score is determined by care provider observations and so is open to interpretation. Conversations among care providers just after a birth can sometimes be heard as they share among themselves their observations if there is a difference in opinion on what the Apgar score should be. It can be helpful for families to know that this is not cause for concern.
Apgar scores can also be a useful way for families to obtain information about the health of their baby and why certain care is administered to their baby.Doulas can help facilitate this education process by asking families if they remember what makes up the Apgar score and encouraging them to inquire with care providers about the individual rating components of their baby’s score. Apgar scores are also helpful for care providers to let parents how their baby is responding to interventions in a quick and easy to understand way. Hearing that a score has changed from 4 to 6 is a clear sign of improvement yet conveys that additional medical support may be needed, for example.
It’s important, also, that doulas know and remind their clients that Apgar scores are not a predictor of a baby’s long term health, as this new policy statement points out. While there are some correlations between Apgar scores and outcomes in large population studies, a low or reassuring Apgar score alone does not indicate what an individual baby’s future health will be.
Resources for More Information
Policy Statement on The Apgar Score from AAP and ACOG (free to access and share)
New articles on the policy statement:
http://www.healio.com/pediatrics/neonatal-medicine/news/online/%7B2a052ccf-dc22-4f27-98ef-187a4ebc57ab%7D/aap-acog-recommend-improved-use-of-apgar-score
http://www.medscape.com/viewarticle/851757