Apgar score

The Apgar Score is a rating system used to evaluate the health of newborn infants. The test is administered one minute after birth and again five minutes after birth. A rating of zero, one, or two is given in each of these five categories: color, breathing, heart rate (pulse), muscle tone, and response to stimulation. A total score of three or lower is a signal that the baby's condition is critical and requires immediate attention. A score of seven or higher means that the baby's initial vital statistics are good. Studies of the extended Apgar Score (the five-minute recheck) have shown the test to be a fairly reliable indicator that the subject infant has a good chance for survival. Because the Apgar Score does not check for all possible complications (such as chromosonal damage), however, a high number does not guarantee that a child's long-term outlook is completely positive.

Apgar Develops System

Until the early 1950s, physicians had no reliable way to assess the health of newborns in the critical first minutes of life. Because of delays in diagnosis, conditions that might have been corrected sometimes proved fatal. In 1952 Virginia Apgar (1909-1974), a physician at the Columbia-Presbyterian Medical Center in New York City, developed a scoring system that became the standard tool for evaluation of newborns. Apgar was one of the first female graduates of Columbia University's College of Physicians and Surgeons; she was also the first woman ever to hold a full professorship at the college. She invented her scoring system after years of studying the effects of anesthesia in childbirth.

Apgar Scoring

The Apgar Score has five important components, each with its own set of acceptable standards. The individual categories and their ranges are listed below:

  • Color: A baby who possesses a healthy pink skin tone receives two points, while a pale or bluish infant receives zero points. Most newborns have pink bodies and lips but bluish hands and feet. This coloring receives one point. An all-over bluish color can mean the baby has problems with his heart or lungs, has something blocking his airway, or has inhaled amniotic fluid.
  • Breathing: A newborn should gasp and begin to breathe at birth. Regular breathing gets a score of two, while irregular breathing gets a score of one. A score of zero is given to a newborn who makes no effort to breathe. Irregular breathing can mean the infant lacks oxygen in his body, has an infection, has central nervous system damage, or has a depressed respiratory drive because of anesthesia given the mother during birth.
  • Pulse: The normal heart rate at birth is between 120 and 160 beats per minute. A newborn with no detectable heartbeat is scored at zero; a heart rate of less than 100 beats per minute is scored one, and a two is given for a heart rate of 100 beats per minute or more.
  • Muscle tone: An infant should move his arms and legs at birth. Limpness or poor muscle tone are usually caused by lack of oxygen, central nervous system trauma, or drugs given the mother during birth. A limp newborn is scored at zero. Some movement gets a score of one, and active movement gets a score of two.
  • Response to stimulation: A newborn is stimulated at birth by inserting a tube through a nostril into the throat. This should cause the infant to grimace, cough, or sneeze. If he does not respond he is scored at zero; a grimace alone gets a one, and a grimace with a cough or sneeze is scored at two.

The highest possible total Apgar Score is ten. It is not unusual for infants to score a seven at one minute of age and nine or ten at five minutes of age. By this later time, babies generally have a healthier skin tone and are breathing better. With information provided by the Apgar Score, medical personnel can take immediate measures if needed to assure a new-born's survival.

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