What Is the Apgar Score?

The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate,
muscle tone, and other signs to see if extra medical care or emergency care is needed.

The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth.
Sometimes, if there are concerns about the baby's condition, the test may be given again.

What Does "Apgar" Mean?

Apgar stands for "Appearance, Pulse, Grimace, Activity, and Respiration."

In the test, five things are used to check a baby's health. Each is scored on a scale of 0 to 2, with
2 being the best score:

Doctors, midwives, or nurses add up these five factors for the Apgar score. Scores are between
10 and 0. Ten is the highest score possible, but few babies get it. That's because most babies'
hands and feet remain blue until they have warmed up.
Apgar Scoring
Apgar Sign 2 1 0
Normal color all Normal color (but Bluish-gray or pale
Appearance over (hands and feet hands and feet are all over
(skin color) are pink) bluish)

Normal (above 100 Below 100 beats Absent

Pulse beats per minute) per minute (no pulse)
(heart rate)

Pulls away, sneezes, Facial movement Absent (no response

coughs, or cries with only (grimace) to stimulation)
Grimace stimulation with stimulation
("reflex irritability")

Active, spontaneous Arms and legs No movement,

Activity movement flexed with little "floppy" tone
(muscle tone) movement

Respiration Normal rate and Slow or irregular Absent (no

(breathing rate and effort, good cry breathing, weak breathing)
effort) cry
How was the Apgar test developed?

At the time Dr. Virginia Apgar began her career, women had great difficulty entering the field of

medicine. In her case, that obscure specialty was anesthesiology. Apgar began studying how

anesthesia could impact mothers and babies. One day, a medical student asked her how to

evaluate the health of a newborn baby, and she simply scribbled a list of what she considered to

be the most important signs. Then she realized that those signs could be combined into a formal

assessment tool to indicate whether a baby requires medical intervention. Apgar tested this

method, and found it to be effective.

When is Apgar testing done?

Apgar testing is typically done at one and five minutes after a baby is born, and it may be

repeated at 10, 15, and 20 minutes if the score is low. The five criteria are each scored as 0, 1, or

2 (two being the best), and the total score is calculated by then adding the five values obtained.

What do Apgar scores mean?

 Apgar scores of 0-3 are critically low, especially in term and late-preterm

infants

 Apgar scores of 4-6 are below normal, and indicate that the baby likely requires

medical intervention

 Apgar scores of 7+ are considered normal (1, 3)

The lower the Apgar score, the more alert the medical team should be to the possibility of the

baby requiring intervention. For example, a baby with a low score is more likely than a baby

with a high score to need resuscitation (however, it is important to note that in certain cases,

resuscitation must be initiated prior to determining the Apgar score). Some components of the
Apgar score are subjective, and there are cases in which a baby requires urgent medical treatment

despite having a high Apgar score.

A low one-minute Apgar score immediately after birth may not indicate that the baby will have

long-term health complications . However, there is evidence to suggest that infants whose Apgar

scores remain low at five minutes or later are much more likely to suffer long-term neurological

damage.

Higher Apgar scores, however, do not rule out the possibility that the baby has a brain injury, In

these cases, physicians must recognize other signs and symptoms of damage and treat them

quickly and appropriately.

What can cause low Apgar scores?

A wide range of pregnancy and birth-related complications can result in low Apgar scores.

Importantly, babies who have been deprived of oxygen often perform poorly on the Apgar test

(although higher scores do not necessarily indicate a lack of oxygen-deprivation). Listed below

are just a few of the complications that can cause a baby to become oxygen-deprived, and may

manifest in low Apgar scores:

 C-Section errors and delays

 Fetal monitoring errors

 Infections

 Maternal medical conditions

 Placental Abruption
  Preterm birth

 Prolonged and arrested labor

 Umbilical cord problems

 Uterine hyperstimulation/tachysystole (this can be caused by the delivery

drugs Pitocin and Cytotec)

 Uterine rupture

When a child has a brain injury such as HIE or cerebral palsy, it is imperative that experts rely on

objective scientific methods and direct observation to determine if the child was exposed to

damaging hypoxia/asphyxia around the time of birth. Clinical markers should be examined and

all possibilities of causes explored so that the cause and timing of the brain injury can be

pinpointed.

What happens if my baby has a low Apgar score?

Some babies with low Apgar scores at birth go on to be perfectly healthy, although they likely

require medical intervention shortly after birth (1). Oftentimes, infants with low Apgar scores or

other risk factors will be moved to the neonatal intensive care unit (NICU) in order to receive

appropriate care. Common medical interventions for newborns with low Apgar scores may

include resuscitation, hypothermia therapy (in cases of HIE), and many other preventative

treatments.

https://www.abclawcenters.com/practice-areas/diagnostic-tests/apgar-score-for-assessment-of-
the-newborn/

https://kidshealth.org/en/parents/apgar.html