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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

 

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