APGAR Scoring

Nimfa B. Estorque

‐ Apgar Scoring was developed in 1953 by Dr. Virginia Apgar who described five signs that could
be determined easily and without interfering with the care of the infant.

‐ The score is named for the preeminent American anesthesiologist Dr. Virginia Apgar (1909-
1974), who invented the scoring method in 1952. Having assisted at thousands of deliveries,
Dr. Apgar wished to focus attention on the baby. Babies were traditionally dispatched directly
to the nursery, often without much formal scrutiny after delivery. Apgar wanted the baby to be
assessed in an organized meaningful manner by the delivery-room personnel. Dr. Apgar was
the first woman to be appointed a full professor at Columbia University's College of Physicians
and Surgeons.

‐ An Apgar score is a quick way for caregivers to see how your newborn is doing right after birth.
The score tells caregivers if a newborn needs special care, such as extra oxygen.

‐ A newborn's Apgar score is checked at one minute and five minutes after birth. The newborn's
Apgar score may also be checked at 10 minutes, and even up to 20 minutes after birth.

Newborns are checked for Appearance (skin color), Pulse (heartbeat), Grimace (reflexes), Activity
(muscles), and Respirations (breathing).

 A rating of 0, 1 or 2 is given to each sign, depending on whether it is absent or present. A score

of 10 indicates a baby in the best possible condition.

 A score of 7-10 is considered normal, while 4-7 might require some resuscitative measure.

 A score of 3 and below requires immediate resuscitation.

 The persistence of low (0-3) Apgar scores at 20 minutes of age is predictive of high rates of
morbidity (disease) and mortality (death).

Activity/Muscle tone refers to the amount of active motion of the extremities.

 0 - Your newborn has limp (weak) muscles.

 1 - Your newborn has some movement in his arms and legs.

 2 - Your newborn moves his arms and legs a lot.

Pulse refers to the heart rate of the newborn during the time of scoring.

 0 - Your newborn has no heartbeat.

 1 - Your newborn's heartbeat is less than 100 beats per minute.

 2 - Your newborn's heartbeat is more than 100 beats per minute.

Grimace/Reflex irritability refers to a response to some form of stimulation such as suctioning the
nose and mouth or rubbing the bottom of his feet. Suctioning with a bulb syringe after delivery to clear
the airway often elicits a response of facial grimacing, sneezing or coughing.

 0 - Your newborn does not react to pain.

 1 - Your newborn frowns but does not move his hand or foot away from pain.

 2 - Your newborn has a strong cry and pulls his hand or foot away from pain.

Appearance - This part of the test checks a newborn's skin color:

 0 - Your newborn's skin is pale or blue all over.

 1 - Your newborn's body is pink, but his hands and feet are blue. This is called acrocyanosis.

 2 - Your newborn's body, hands, and feet are all pink.

Respiration - This part of the test checks how fast, how deep, and how strong a newborn is
breathing:

 0 - Your newborn is not breathing.

 1 - Your newborn has slow, weak breaths that are not regular.

 2 - Your newborn has a strong cry and takes full breaths.