The Apgar score or newborn scoring is a method to summarize the baby’s health status soon after birth. Vital parameters, such as heart rate and respiratory rate, are included in the Apgar scoring system.
The Apgar score is usually performed twice on a baby, first at one minute after birth and again at five minutes after birth. If there are any concerns, the Apgar score may be re-evaluated. However, Apgar scores alone do not predict the mortality or neurological health of a newborn.
Read this post to know more about how, when, and why the Apgar score is evaluated and what a normal or abnormal Apgar score means.
What Does “Apgar” Mean?
The Apgar score was developed in 1952 by Virginia Apgar, an anesthesiologist at New York-Presbyterian Hospital, to evaluate obstetric anesthesia’s effects on newborns. Each letter in ‘Apgar’ stands for a parameter measured in a baby’s health status after birth.
The following five parameters are assessed in the Apgar scoring system (1).
- Appearance (skin color)
- Pulse (heart rate)
- Grimace (reflex)
- Activity (muscle tone)
- Respiration (breathing rate)
How Is The Test Performed?
A doctor, nurse, or midwife assesses the Apgar score of a baby based on physical examination at one minute and five minutes after birth (2).
Skin color and muscle tone are evaluated by observing the newborn. Heart rate is estimated using a stethoscope or feeling for pulse at the base of umbilical cord. Listening to an infant’s cry and respiration may help determine the newborns’ breathing rate and effort. Doctors may stimulate the baby with a mild pinch to observe a grimace response. Pinching causes a reflex in response to stimulation.
Based on the results of physical examination, each parameter’s score is given according to the Apgar scoring chart. Each of the five parameters is assessed on a scale of zero to two. Thus, the total score can be between zero and ten.
You may refer to the following table for parameters of Apgar scoring (3).
|Normal skin color all over the body||Hands and feet are blue; other parts of the body have a normal color||Blue or pale body-color|
|Normal, Above 100 beats per minute|
|Below 100 beats per minute||No pulse|
|Grimace||Pulls away, coughs, sneezes, or cries with stimulation|
|Stimulation causes only facial movement||No response on stimulation|
|Activity||Active and spontaneous movements||Less movement; arms and legs are flexed||Floppy tone or no movements|
|Respiration||A loud cry, normal breathing efforts||Weak cry, irregular or slow breathing||No breathing|
Some babies may be able to score the maximum in the initial evaluation. However, many babies may have low scores until they warm up. So, the score can be low in the first assessment and improve the next time.
What Does A Normal Apgar Score Mean?
Babies with good health will have scores of 7 or above. A newborn with a score of 7,8, or 9 is normal and may not require any immediate medical care.A score of 10 is infrequent since many babies may have bluish extremities soon after birth (4).
A score below seven does not mean that the baby is unhealthy. It indicates that your baby may need immediate medical care, such as oxygen or airway suctioning, to improve breathing. Healthy babies may also have low scores on the initial evaluation, and the score usually improves after a few minutes.
What Does An Abnormal Apgar Score Mean?
A slight reduction in Apgar score, especially one minute after birth, is typical. The following factors can be the reason for a lower Apgar score at the one-minute mark evaluation (5).
- Cesarean delivery
- High-risk pregnancies
- Labor and delivery complications
- Premature birth
- Fluid in the newborn’s airway
If the score is less than 7 at the five-minute mark, the Apgar score is measured every five minutes for the next 20 minutes (6). If the score continues to remain low, the baby may require medical care and close monitoring.
Babies with low scores usually improve after airway clearing and oxygen supplementation. Some babies may require artificial breaths or cardiopulmonary resuscitation to stimulate heart functioning.
Apgar test is not a predictor of babies’ long-term health, intelligence, or behavior. It is only meant to assess a newborn’s physical well-being immediately after birth and determine if the baby needs any medical care. Do not be concerned about the effect of Apgar score on the baby’s life. Most babies do well once they begin to adjust to life outside the womb.
2. Apgar Score;University of California, San Francisco
3. The Apgar Score;American College of Obstetricians and Gynecologists
4. Apgar Scores; Healthychildren; American Academy of Pediatrics
5. Apgar Score; MedlinePlus; The United States National Library of Medicine
6. The Apgar Score;American Academy of Pediatrics