What is the Apgar score?

Ninety percent of term infants make a successful and uneventful transition from living within the womb to the outside
world. About 10% will need some medical intervention and approximately 1% will require extensive resuscitation. A
reproducible and rapidly determined rating system is necessary for evaluation the newborn infant. The Apgar score is
a practical method for assessing a neonate.

How is the Apgar score done?

The Apgar score is a number calculated by scoring the heart rate, respiratory effort, muscle tone, skin color, and
reflex irritability (response to a catheter in the nostril). Each of these objective signs can receive 0, 1, or 2 points.

What does a high or low Apgar score mean?

A perfect Apgar score of 10 means an infant is in the best possible condition. An infant with an Apgar score of 0-3
needs immediate resuscitation. It is important to note that diligent care of the newborn is an immediate response to
the current status of the infant. It is inappropriate to wait until Apgar scores are obtained to begin or continue to
address the needs of the neonate.

When is the Apgar scoring done?

The Apgar score is done routinely 60 seconds after the birth of the infant and then is repeated five minutes after birth.

In the event of a difficult resuscitation, the Apgar score may be done again at 10, 15, and 20 minutes.

What does a persistently low Apgar score mean?

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

Why was the Apgar score developed?

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.

Apgar Scoring
  Sign 0 points 1 point 2 points
Activity
A limp limbs flexed active movement
(Muscle tone)
Pulse
P absent < 100 /min > 100 /min
(heart rate)
cough or sneeze
Grimace (nose)
G absent grimace
(response to smell or foot slap) cry and withdrawal
of foot (foot slap)
Appearance body pink
A blue pink all over
(color) extremities blue
 Respiration irregular
R absent good strong cry
(breathing) weak crying

The total Apgar score is the sum of the scores for the five signs.