Apgar Score

figure 1

The Apgar score is a test used to measure the vital signs of a baby at birth (fig. 1).

Virginia Apgar, M.D. (1909-1974) introduced the Apgar score in 1952. This test is a screening tool for health-care providers to determine what assistance is immediately necessary to help a newborn stabilize.

The Apgar score is now used worldwide to quickly assess the health of an infant one minute and five minutes after birth. The 1-minute Apgar score measures how well the newborn tolerated the birthing process. The 5-minute Apgar score assesses how well the newborn is adapting to the environment.

What Will Happen?

At one and five minutes after your baby is born, the attending health-care provider will assess five vital areas of newborn health. The Apgar score uses measures of 0, 1, or 2 for each category, with the best possible total score equaling 10.

1. Heart Rate:
   
   a. Absent heartbeat = 0.
   b. Slow heartbeat (less than 100 beats per minute) = 1.
   c. Adequate heartbeat (more than 100 beats per minute) = 2.



2. Respiration:
   
   a. Not breathing = 0.
   b. Weak cry, irregular breathing = 1.
   c. Strong cry = 2.



3. Muscle Tone:
   
   a. Limp, flaccid = 0.
   b. Some flexing or bending = 1.
   c. Active motion = 2.



4. Response to Stimulation (also called Reflex Irritability):
   
   a. No response = 0.
   b. Grimace = 1.
   c. Vigorous cry or withdrawal = 2.



5. Color:
   
   a. Pale or blue = 0.
   b. Normal color body but blue extremities = 1.
   c. Normal color = 2.

Results

A score of seven to 10 is normal and indicates your newborn is in good condition. Mucus may need to be suctioned from the baby's airway. A score of 10 is very unusual. Almost all newborns lose one point for blue hands and feet.

Any score less than seven indicates your baby needs assistance stabilizing and health-care personnel should take appropriate action, for example, helping the infant breathe. The Apgar score may be repeated at 10 minutes and later to assess the effectiveness of the intervention or treatment.

Frequently Asked Questions

Q: Does the Apgar score predict the future health of my baby?

A: In general the Apgar score alone does not predict the future health of the baby. A low 5-minute Apgar score has been associated with a slight increased risk for cerebral palsy in full-term infants. However, 75% of children who develop this central nervous system disorder had normal Apgar scores.

Q: Does my child's Apgar score predict how smart he will be?

A: Apgar scores assess the health and well-being of an infant at birth. They do not predict a child's ability to perform well academically.

Q: I've seen APGAR written in all-caps. Isn't it an acronym?

A: The Apgar score was originally named after its creator, Virginia Apgar, M.D. After the Apgar score became standard, the categories were renamed to form the acronym APGAR:

• Appearance (Color)
• Pulse (Heart Rate)
• Grimace (Response to Stimulation)
• Activity (Muscle Tone)
• Respiration (Respiration)

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.

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