Pediatric vitals signs

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The APGAR Score

 

The first vitals are recorded at birth. In 1952, Virginia Apgar, an anesthesiologist, after assisting in the delivery of >17,000 babies, developed a scoring system to assess asphyxia and predict neurologic outcomes in newborns.

The scale, named after her, consists of five parameters: heart-rate, respirations, reflex irritability, muscle tone and color. A score is assigned at one minute and five minutes after birth. Most newborns have a score between 7 and 10; from 4-6 is moderately depressed, and 0-3 is severely depressed requiring resuscitative measures. If the 5 minute score is less than 7, scores are done every 5 minutes for 20 minutes.

Apgar’s last name has been used as an acronym for remembering the system:

• A—Appearance (color)
• P—Pulse
• G—Grimace (reflex irritability)
• A—Activity (muscle tone)
• R—Respirations

Table: APGAR score :

Sign	0	1	2
Heart rate	absent	slow(<100/min)	>100/min
Respirations	absent	slow, irregular	good, crying
Muscle tone	limp	some flexion	active motion
Reflex irritability	no response	grimace	cough or sneeze
Color	blue or pale	pink body with blue extremites	completely pink