APGAR SCORING

One of the standardized assessments done to evaluate the newborn

quickly at birth is the Apgar Scoring. This assessment is done at the first 1
minute and 5 minutes after birth, newborns are observed and rated
according to an Apgar score, an assessment scale used since 1958.
Heart rate, respiratory effort, muscle tone, reflex irritability and color
of the infant are each rated 0, 1, or 2; the five score are then added.

Score interpretation as follows:

 A newborn whose total sore is less than 4 is in serious danger
and needs resuscitation.
 A score of 4-6 means that the infant’s condition is guarded and
the baby may need clearing of the airway and supplementary
oxygen.
 A score of 7-10 is considered good, indicating that the infant
scored as high as 70% to 90% of all infants at 1 to 5 minutes (A
score of 10 is the highest score possible).

The Apgar score standardizes infant assessment at birth and serves as

the baseline for future evaluation. There is a high correlation between a 5-
minute Apgar scores and mortality and morbidity, particularly neurologic
morbidity.

APGAR SCORING CHART

SIGN 0 1 2
Heart rate Absent Slow(<100) >100
Respiratory effort Absent Slow, irregular, weak Good, strong cry
cry
Muscle tone Flaccid Some flexion of Well flexed
extremities
Reflex irritability
Response to
catheter in nostril No response Grimace Cough or sneeze
or No response Grimace Cry or withdrawal of
Slap to sole of foot
foot
Color Blue, pale Body normal Normal skin coloring
pigment (pinkish), (completely pinkish)
Extremities blue
(acrocyanosis)

The following points should be considered in obtaining Apgar rating:

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  Heart rate. Auscultating a newborn heart rate with a sensitive
stethoscope is the best way to determine heart rate; however,
heart rate also may be obtained by observing and counting the
pulsations of the cord at the abdomen if the cord is still uncut.
 Respiratory effort. Respirations are counted by watching
respiratory movements. A mature newborn usually cries and
aerates the lungs spontaneously at about 30 seconds after birth.
By 1 minute, he or she maintains regular, although rapid,
respirations. Difficulty with breathing might be anticipated in a
newborn whose mother received a large dose of analgesia or a
general anesthesia during labor or birth.
 Muscle tone. Mature newborns hold their extremities tightly
flexed, simulating their intrauterine position. Muscle tone is
tested by observing their resistance to any effort to extend their
extremities.
 Reflex irritability. One of two possible is used to evaluate
reflex irritability in a newborn: response to suction catheter in
the nostrils and response to having the soles of the feet slapped.
A baby whose mother was heavy sedated will probably
demonstrate a low score in this category.
 Color. All infants appear cyanotic at the moment of birth. They
grow pink with or shortly after the first breath, which makes the
color of the newborns correspond to how well they are breathing.
Acrocyanosis (cyanosis of the hands and feet) is common in
newborns that a score of 1 in this category can be thought of
normal.

Reference:

Adele, P. (2007). Maternal & Child Health Nursing: Care of the

Childbearing and Childrearing Family. Lippincott Williams & Wilkins.

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Prepared by:

Flor, Phillip Daeniel D.U

BSN 3C

Submitted to:

Ms. Nedly Lozano, R.N.

Clinical Instructor