| ARCHETYPE ID | openEHR-EHR-OBSERVATION.apgar.v2 |
|---|---|
| Concept | Apgar score |
| Description | A tool to assess the clinical status of the newborn infant immediately after birth and their response to resuscitation. |
| Use | Use to record the results for each component parameter and their total sum for the Apgar score. This archetype has been designed to support the explicit recording of Apgar scores at 1, 2, 3, 5 and/or 10 minute points in time offset from the time of birth, plus additional events as required. Usual practice is to document the Apgar score at 1 and 5 minutes; further scores can be recorded as clinically indicated. It is possible to record the Apgar score at any time after birth using this archetype. Common clinical practice is to record all 5 parameters plus the total, however this archetype allows any partial information to be recorded, if that is all that is available for example from historical data. |
| Purpose | To record the results for each component parameter and their total sum for the Apgar score. |
| References | Apgar V. A proposal of a New Method of Evaluation of the Newborn Infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7. Apgar V, Holaday DA, James LS, Weisbrod IM, and Berrien C. Evaluation of the newborn infant; second report. J Am Med Assoc. 1958 Dec 13;168(15):1985-8. Apgar V. The newborn (Apgar) scoring system. Pediatr Clin North Am. 1966 Aug;13(3):645-50. Whaley LF, Wong DL (1979). Nursing Care of Infants and Children. St. Louis, Toronto, London, The C.V. Mosby Company. |
| Copyright | © openEHR Foundation |
| Authors | Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2004-05-18 |
| Other Details Language | Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2004-05-18 |
| Other Details (Language Independent) |
|
| Keywords | newborn, index, score, birth, infant, neonate, assessment |
| Lifecycle | published |
| UID | 9ebf359c-bfcc-41ab-9353-3ed976cab252 |
| Language used | en |
| Citeable Identifier | 1246.145.2172 |
| Revision Number | 2.0.5 |
| protocol | |
| Extension | Extension: Additional information required to extend the model with local content or to align with other reference models or formalisms. For example: local information requirements; or additional metadata to align with FHIR. Include: All not explicitly excluded archetypes |
| events | |
| 1 minute | 1 minute: Apgar score 1 minute after birth. Offset: 1 minute |
| 2 minute | 2 minute: Apgar score 2 minutes after birth. Offset: 2 minutes |
| 3 minute | 3 minute: Apgar score 3 minutes after birth. Offset: 3 minutes |
| 5 minute | 5 minute: Apgar score 5 minutes after birth. Offset: 5 minutes |
| 10 minute | 10 minute: Apgar score 10 minutes after birth. Offset: 10 minutes |
| Any event | Any event: Apgar score at any additional time, as required. |
| data | |
| Respiratory effort | Respiratory effort: Observation of the infant's respiratory effort. 0: Absent [No effort to breath.] [ This term binding has NOT yet been formally reviewed or confirmed. 1: Weak or irregular [Some effort to breath, moving chest.] [ This term binding has NOT yet been formally reviewed or confirmed. 2: Normal [Breathing normally or crying.] [ This term binding has NOT yet been formally reviewed or confirmed. |
| Heart rate | Heart rate: Recording of the infant's heart rate. 0: Absent [No heart beat is seen, felt or heard.] [ This term binding has NOT yet been formally reviewed or confirmed. 1: <100 beats per minute [Heart rate less than 100 beats per minute.] [ This term binding has NOT yet been formally reviewed or confirmed. 2: ≥100 beats per minute [Heart rate greater than or equal to 100 beats per minute.] [ This term binding has NOT yet been formally reviewed or confirmed. |
| Muscle tone | Muscle tone: Observation of the infant's muscle tone. 0: Limp or flaccid [No spontaneous movement.] [ This term binding has NOT yet been formally reviewed or confirmed. 1: Reduced tone [Some flexion of extremities.] [ This term binding has NOT yet been formally reviewed or confirmed. 2: Normal tone [Normal, vigorous movements.] [ This term binding has NOT yet been formally reviewed or confirmed. |
| Reflex irritability | Reflex irritability: Observation of the response of the infant to an irritant stimulation, for example, suctioning the oropharynx and nares with a soft rubber catheter. 0: No response [No response to stimulation.] [ This term binding has NOT yet been formally reviewed or confirmed. 1: Reduced response [Grimace or feeble cry when stimulated.] [ This term binding has NOT yet been formally reviewed or confirmed. 2: Normal response [Grimace, sneeze, cough or pulls away when stimulated.] [ This term binding has NOT yet been formally reviewed or confirmed. |
| Skin colour | Skin colour: Observation of the skin colour of the infant. 0: Completely blue [Body and extremities are blue.] [ This term binding has NOT yet been formally reviewed or confirmed. 1: Body pink; extremities blue [Body is pink; extremities are blue.] [ This term binding has NOT yet been formally reviewed or confirmed. 2: Completely pink [Body and extremities are pink; no cyanosis.] [ This term binding has NOT yet been formally reviewed or confirmed. |
| Total | Total: The total sum of each component parameter for the Apgar score. If the total is to be calculated, it is necessary for all 5 component values to be recorded. min: >=0; max: <=10 |
| Other contributors | Silje Ljosland Bakke, Helse Vest IKT AS, Norway (openEHR Editor) Paul Donaldson, Nursing Informatics Australia, Australia Sebastian Garde, Ocean Informatics, Germany Anneke Goossen, Results 4 Care, Netherlands Anne Harbison, CPCER, Australia Sam Heard, Ocean Informatics, Australia Omer Hotomaroglu, Turkey Pieter Hummel, Medisch Centrum Alkmaar, Netherlands Andrew James, University of Toronto, Canada Heather Leslie, Atomica Informatics, Australia (openEHR Editor) Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (openEHR Editor) |
| Translators |
|