Apgar Score
Score 8 to 10
Apgar scores of 8 to 10 are achieved by 90% of all neonates.
Normally, nothing is required except nasal and oral suctioning, drying of the skin,
and maintenance of normal body temperature. A careful reevaluation of the neonate's
condition should occur at 5 minutes of age because some neonates hypoventilate when
stimulation ceases. When stable, the neonate should be wrapped in a warm blanket
and handed to the parents.
Score 5 to 7
Neonates who have Apgar scores of 5 to 7 have suffered mild asphyxia
just before birth. They usually respond to vigorous stimulation and to oxygen blown
over the face. If they are slow to respond and to become pink, they should be ventilated
with 80% to 100% oxygen by bag and mask. By 5 minutes of age, patients who have
Apgar scores of 5 to 7 at 1 minute are usually well. At 2 minutes of age, PaO2
is usually 50 to 70 mm Hg (FIO2
= 0.21),
PaCO2
is 40 to 50 mm Hg, and pHa is about
7.15. The base deficit is approximately 12 mEq/L. By 10 minutes of age, the pHa
increases to 7.30, and PaCO2
decreases
to below 40 mm Hg. The base deficit usually returns to normal (-3.0 to +3.0 mEq/L).
Score 3 to 4
Neonates with Apgar scores of 3 to 4 are moderately depressed
at birth. They typically are usually cyanotic and have poor respiratory efforts,
but they usually respond to bag-and-mask ventilation, breathe, and become pink.
If they have not breathed spontaneously, ventilating the lungs with a bag and mask
may be difficult because the airway resistance exceeds that of the esophagus. If
so, gas may preferentially enter and distend the esophagus, stomach, and gut, which
may interfere with ventilation and cause vomiting and regurgitation. Decompressing
the stomach makes it easier to ventilate the lungs. If the neonate has not breathed
or is breathing ineffectively, an endotracheal tube should be inserted before ventilating
the lungs. Umbilical artery and vein blood should be obtained from a double-clamped
segment of umbilical cord to measure blood gases and pH. The blood gases are frequently
abnormal: PaO2
below 20 mm Hg, PaCO2
above 60 mm Hg, and pHa below 7.15. If the pH and base deficit are unchanged or
worse on a sample of blood obtained from a radial artery, an umbilical artery catheter
should be inserted, and if necessary, sodium bicarbonate should be administered.
Score 0 to 2
Neonates with Apgar scores of 0 to 2 are severely asphyxiated
and require immediate resuscitation. It is not appropriate to wait to see how the
patient will do. The patient's condition usually worsens. Get on with the resuscitation!
What follows is a discussion of resuscitation of severely asphyxiated neonates (Apgar
scores of 0 to 2).
