Definition of Apgar score. Apgar score: An objective score of the condition of a baby after birth. This score is determined by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs receives 0, 1, or 2 points.
In rare cases, the test will be done 10 minutes after birth.
Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.
The Apgar test is done by a doctor, midwife, or nurse. The health care provider examines the baby’s:
Each category is scored with 0, 1, or 2, depending on the observed condition.
Heart rate is evaluated by stethoscope. This is the most important assessment:
Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:
This test is done to determine whether a newborn needs help breathing or is having heart trouble.
The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.
Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother’s womb.
Most of the time a low Apgar score is caused by:
A baby with a low Apgar score may need:
Most of the time, a low score at 1 minute is near-normal by 5 minutes.
A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.
The five criteria of the Apgar score:
|Score of 0||Score of 1||Score of 2||Component of acronym|
|Complexion||blue or pale all over||blue at extremities|
body and extremities pink
|Pulse rate||absent||< 100 beats per minute||> 100 beats per minute||Pulse|
|Reflex irritability grimace||no response to stimulation||grimace on suction or aggressive stimulation||cry on stimulation||Grimace|
|Activity||none||some flexion||flexed arms and legs that resist extension||Activity|
|Respiratory effort||absent||weak, irregular, gasping||strong, lusty cry||Respiration|
The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.
A low score on the one-minute test may show that the neonate requires medical attention but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times—such as 10, 15, or 30 minutes—may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test’s purpose is to determine quickly whether a newborn needs immediate medical care. It is not designed to predict long term health issues.
A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant average difference in the first Apgar score, but not the second. Oxygen saturation (see Pulse oximetry) also was lower at high altitude.
Some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.
Spanish: Apariencia, Pulso, Gesticulación, Actividad, Respiración;
Portuguese: Aparência, Pulso, Gesticulação, Atividade, Respiração;
French: Apparence, Pouls, Grimace, Activité, Respiration;
German: Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order (respiration, pulse, muscle tone, appearance, reflex).
Another eponymous backronym from Virginia Apgar’s name is American Pediatric Gross Assessment Record.
Another mnemonic for the test is “How Ready Is This Child?” — which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.