APGAR Score

Introduction

The Apgar score is a quick assessment of a newborn’s condition right after birth. Dr. Virginia Apgar, an anesthesiologist at Columbia University, introduced it in 1952 and published it in 1953. It became a standard part of delivery-room care worldwide. It gives the delivery team a consistent way to see how a baby is adjusting to life outside the womb and whether more support is needed. The score is named after Dr. Apgar, and the letters were later turned into a memory aid for its five signs: Appearance, Pulse, Grimace, Activity, and Respiration.

What it assesses

Each of the five signs is scored 0, 1, or 2 points:

How it’s scored

The five scores are added for a total from 0 to 10. The score is given at 1 minute and 5 minutes after birth. If the 5-minute score is below 7, scoring is usually repeated every 5 minutes up to 20 minutes.

How results are interpreted

• 7–10: Reassuring. The baby is adjusting well.

• 4–6: Moderately abnormal. The baby may need some help, such as stimulation or help breathing.

• 0–3: Low. The baby needs immediate care.

A perfect 10 is uncommon, because most newborns still have bluish hands and feet in the first minutes, which scores a 1 for appearance. Scores of 7, 8, or 9 are completely normal.

• Perform on every live newborn, regardless of gestational age, at 1 and 5 minutes of life.

• Per Neonatal Resuscitation Program (NRP), scoring continues at 5 minute intervals until reaching a score of 7 or until 20 minutes of life is encountered.

• It should NOT be used to predict individual risk of mortality and adverse neurologic outcome.

• Gestational age, maternal sedation, congenital malformations, trauma, inter-observer variability may affect APGAR scoring.

• The 5 criteria are not of equal significance. The original article noted that HR and respiratory effort were most important, while color was least important.

• The 5 minute score is regarded as the better predictor of survival.

For parents: A lower 1-minute score is common, especially after a long or difficult labor or a cesarean birth, and most babies improve by 5 minutes. The Apgar score is meant to guide care in the first minutes after birth. It doesn’t measure intelligence or predict a child’s long-term health or development.

Limitations

The Apgar score isn’t used to decide when to start resuscitation. Care begins immediately if a baby isn’t breathing, without waiting for the 1-minute score. Scores can be affected by prematurity, medications given to the mother during labor, and some birth conditions, and scoring involves some judgment, so different observers may score slightly differently. A low 5-minute score is linked to higher risk for newborns as a group, but the Apgar alone can’t diagnose a lack of oxygen at birth or predict an individual baby’s future.

APGAR V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7.