I.

APGAR SCORE
➢The APGAR SCORE is named in honor of DR. VIRGINIA APGAR
➢One of Columbia University’s first female MD (1933) and of
the first American women to specialize in surgery
➢DR. APGAR realized that:
“Birth is the most hazardous time of life”,
she created a system for quickly and accurately
assessing a baby’s health in the crucial
minutes after birth.
➢The intent of this scoring system is to help identify newborns
at risks of complications
➢A score is given for each sign at one minute and five minutes
after birth
➢If there are problems with the newborn, an additional score is
given at 10 minutes
➢A score of 7-10 is considered normal
➢4-7-require some resuscitative measures
➢A score of 3 and below- requires immediate resuscitation
 SIGNS 0 POINT 1 POINT 2 POINTS
Appearance: Skin Pale all Pink body, pink all over
A Color over, blue
blue-gray extremities

P Pulse Rate Absent Below Above

100bpm 100bpm
No With slight Sneeze,
G Grimace Response grimace coughs,
pulls away
A Activity:Muscle Absent, Arms and Active
Tone Limp/ legs flexed movement
flaccid
R Respiration: Absent weak/ Good cry
irregular
Purpose: To assess the newborn’s well being
Assessment:
1.Check for the completeness and functionality of the
materials/equipment needed
Rationale: Identifies safety hazards that could cause or
potentially lead to harm.
2.Check for air drafts by holding a piece of tissue on air. Adjust
the room’s temperature.
Rationale: To prevent cold stress on the newborn upon delivery.
Normal Value:
1.Temperature – 99 degrees F (37.2 degrees C) at the moment of birth
Rationale:
newborn have been confined in an internal body organ (mother’s warm
and supportive uterus
Temperature will fall almost immediately to below normal because of heat
loss
The temperature of birthing rooms approximately 68 degrees to 72
degrees (21 degrees to 22 degrees C) and the infant’s immature
temperature regulating mechanism if the baby is not protected from heat
loss at birth and in the moments afterward
 The majority of heat loss occurs because of four separate
mechanisms:
1. Convection – is the flow of heat from the newborn’s body surface to
cooler surrounding air
Management: Eliminating drafts, such as from air conditioner is an important
way to reduce convection heat loss
2. Conduction – is the transfer of body heat to a cooler solid object in
contact with the baby.
Example: baby is placed on a cold counter or on the cold base of a warming
unit
Management: covering surfaces with a warmed blanket or towel is
necessary to help minimize conduction heat loss
c. Radiation – is the transfer of body heat to a cooler solid object not in
contact with the baby.
Example: cold window or air conditioner
Management: Moving an infant as far as from the cold surface as possible
helps reduce this type of heat loss
d. Evaporation- is loss of heat through conversion of a liquid to a vapor
Rationale: newborns are wet when born, so they can lose a great deal of
heat as the amniotic fluid on their skin evaporates
Management: lay a newborn on the mother’s abdomen immediately after
birth and cover with a warm blanket for skin to skin contact
Assessment: assess for the following: can be done during the actual
procedure
a.Color—all infants appear cyanotic at birth and become pink with or
shortly after the first breath; Method Used: Inspection
b.Heart Rate—auscultation of the newborn’s heart rate
• Place bell of stethoscope under the infant’s left nipple and count the heart
rate in one full minute
• 2 beats = 1 count; Method used: Auscultation
> Heart rate-is the number of times the heart beats per minute
> Apical pulse is auscultated with a stethoscope over the chest where the
heart's mitral valve is best heard. In infants and young children, the apical
pulse is located at the fourth intercostal space at the left midclavicular line.
 Infant’s Heart Rate – immediately after birth, as rapid as 180 beats per
minute
 Within an hour after birth, as the newborn settles down to sleep, the HR

stabilizes to an average of 120 to 140 beats per minute

 During crying, the HR may range from 90 to 110 beats per minute
 HR may remain irregular due to immaturity of the cardiac regulatory center

in the medulla and transient murmurs may result from the incomplete
closure of fetal circulation shunts
c. Reflex irritability- Response to a suction catheter or having the soles of
their feet slapped; Method Used: Inspection
d. Muscle tone - Newborn hold the extremity tightly flex. They should resist
any effort to extend their extremities; Method Used: Inspection
e. Respiratory effort - A mature newborn usually cries spontaneously at
about 30 seconds after birth. At one minute, the infant is maintaining regular
although rapid respirations.
 For the first few minutes of life- as high as 90 breaths per minute
 As respiratory activity is established and maintained over the next hour-
will settle at an average of 30- 60 breaths/minute
 Respiratory depth, rate and rhythm are likely to be irregular
 Short period of apnea (without cyanosis) called periodic respirations are
normal during this time
 Watch the movement of a newborn’s abdomen because breathing
primarily involves the use of diaphragm and abdominal muscles
 Coughing and sneezing reflexes are present at birth and help clear the
airway; Method Used: Inspection
PLANNING:
1.Gather and prepare the needed materials
Rationale: Ensuring that all materials are complete and functions well save
the nurses’ time and effort.
Materials:
> Pre warmed crib or bassinet
> Stethoscope
>Adequate source of light

> A pair of sterile gloves

2.Do hand hygiene and wear gloves. Observe appropriate infection control
procedures.
Rationale:
> Hand hygiene and PPE prevent the spread of microorganisms.
> PPE is required based on transmission precautions
PROCEDURE
1.Identify the newborn by checking the wrist band.
Rationale: To ensure that the right infant receives the intended procedure and
helps prevent errors.
2.Proceed on the APGAR SCORING: Refer to the Table
Scoring:
a .4-6 points—the baby’s condition is guarded and may need more extensive
clearing of the airway and supplementary oxygen.
b. 0-3 points—the baby is serious danger and need immediate resuscitation.
c. 7-10 points—are considered good and in the best possible health.
3.Report any abnormal findings to the attending physician
Rationale: To ensure immediate medical management.
4.Keep the baby warm after the procedure.
Rationale: To prevent heat loss.
5.Gather the materials, discard non-reusable and rearrange reusable
ones.
Rationale: To maintain the orderliness of the workplace.
6.Remove gloves and other PPE. Discard properly. Do hand washing.
Rationale: Proper removal and hand washing prevent the spread of
microorganism.
7.Document the procedure and other important data on the client’s chart.
Rationale: Provides record of the client’s care and serves as a baseline for
further management
 P
 S
 A
 P
 S
 H
 NEUROMUSCULAR MATURITY

1. Posture
 Mature - baby’s arms should be flexed or bent in
 Premature – baby’s arms are extended of flaccid
2. Square window
 Assess the wrist flexibility of the baby
Procedure: bend the hand all the way down until it hits the arm
 Mature- the examiner must be able to do it without resistance from the baby
 Premature - the examiner cannot bend the baby’s hand even to 90 degrees
3. ARM RECOIL- holding the infant’s arms from being flexed and pull it down
 Mature - the baby’s arms should recoil back
 Premature – the baby’s arms does not recoil
4. POPLITEAL ANGLE- taking the infant’s leg and bringing it up in an angle,
 Mature – there is resistance is felt by the examiner, cannot bring the leg
more than 90 degrees
 Premature- if leg can be brought up even to baby’s face
5. SCARF SIGN – taking the baby’s arm and moving it across the baby’s
chest
 Mature- if there is resistance felt by the examiner
 Premature – if the arm can be wrapped around the baby’s chest
6. HEAL TO EAR – bending the knee
 Mature – there is resistance felt by the examiner
 Premature – if the leg can be brought all the way to the ear
 PLAY ANIMATION