Sign
0 points
1 point
2 points
A
Activity (Muscle tone)
limp
limbs flexed
active movement
P
Pulse (heart rate)
absent
< 100 /min
> 100 /min
G
Grimace (response to smell or foot slap)
absent
grimace
cough or sneeze (nose) cry and withdrawal of foot (foot slap)
A
Appearance (color)
blue
body pink extremities blue
pink all over
R
Respiration (breathing)
absent
irregular weak crying
good st
The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal. A low score on the one-minute test may show that the neonate requires medical attention [3] but is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longerterm neurological damage. There is also a small but significant increase of the risk of cerebral of cerebral palsy. palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it wasnot designed to make long-term predictions on a child's health. [1] A score of 10 is uncommon due to the prevalence of transient transient cyanosis, and is not substantially different from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study comparing babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant difference in the first but not the second Apgar score. Oxygen saturation (see Pulse oximetry) oximetry) also was lower at high altitude. [4]
A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.
A P G A R
Sign Activity (Muscle Tone)
0 Points
1 Point
2 Points
Absent
Arms and Legs Flexed
Active Movement
Pulse Grimace (Reflex Irritability) Appearance (Skin Color) Respiration
Absent
Below 100 bpm
No Response
Grimace
Blue-gray, pale all over Absent
Normal, except for extremities Slow, irregular
Above 100 bpm Sneeze, cough, pulls away Normal over entire body Good, crying
About the Apgar Score The very first test given to your newborn, the Apgar score occurs right after your baby's birth in the delivery or birthing room. The test was designed to quickly evaluate a newborn's physical condition after delivery and to determine any immediate need for extra medical or emergency care. Although the Apgar score was developed in 1952 by an anesthesiologist named Virginia Apgar, you may have also heard it referred to as an acronym for: Activity, Pulse, Grimace,Appearance, and R espiration. The Apgar test is usually given to your baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Rarely, if there are concerns about the baby's condition and the first two scores are low, the test may be scored for a third time at 10 minutes after birth. Five factors are used to evaluate the baby's condition and each factor is scored on a scale of 0 to 2, with 2 being the best score: 1. activity and muscle tone 2. pulse (heart rate)
3. grimace response (medically known as "reflex irritability") 4. appearance (skin coloration) 5. respiration (breathing rate and effort) Doctors, midwives, or nurses add these five factors together to calculate the Apgar score. Scores obtainable are between 10 and 0, with 10 being the highest possible score. Apgar Scoring Apgar Sign
2
Heart Rate (pulse)
Normal (above Below 100 100 beats per beats per minute) minute
Absent (no pulse)
Breathing (rate and effort)
Normal rate and effort, good cry
Slow or irregular breathing, weak cry
Absent (no breathing)
Grimace(responsiveness or "reflex irritability")
Pulls away, sneezes, or coughs with stimulation
Facial movement only (grimace) with stimulation
Absent (no response to stimulation)
Activity (muscle tone)
Active, spontaneous movement
Arms and legs No movement, flexed with "floppy" tone little movement
Appearance (skin coloration)
Normal color all Normal color Bluish-gray or over (hands (but hands pale all over and feet are and feet are pink) bluish)
What Apgar Scores Mean
1
0
A baby who scores a 7 or above on the test at 1 minute after birth is generally considered in good health. However, a lower score doesn't necessarily mean that your baby is unhealthy or abnormal. But it may mean that your baby simply needs some special immediate care, such as suctioning of the airways or oxygen to help him or her breathe, after which your baby may improve. At 5 minutes after birth, the Apgar score is recalculated, and if your baby's score hasn't improved to 7 or greater, or there are other concerns, the doctors and nurses may continue any necessary medical care and will closely monitor your baby. Some babies are born with heart or lung conditions or other problems that require extra medical care; others just take a little longer than usual to adjust to life outside the womb. Most newborns with initial Apgar scores of less than 7 will eventually do just fine. It's important for new parents to keep their baby's Apgar score in perspective. The test was designed to help health care providers assess a newborn's overall physical condition so that they could quickly determine whether the baby needed immediate medical care. It was not designed to predict a baby's long-term health, behavior, intellectual status, or outcome. Few babies score a perfect 10, and perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth. Keep in mind that a slightly low Apgar score (especially at 1 minute) is normal for some newborns, especially those born after a high-risk pregnancy, cesarean section, or a complicated labor and delivery. Lower Apgar scores are also seen in premature babies, who usually have less muscle tone than full-term newborns and who, in many cases, will require extra monitoring and breathing assistance because of their immature lungs. If your doctor or midwife is concerned about your baby's score, he or she will let you know and will explain how your baby is doing, what might be causing problems, if any, and what care is being given. For the most part, though, most babies do very well, so relax and enjoy the moment!
The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria of the Apgar score Score 0
Score 1
Score 2
Heart rate
absent
<100
>100
Respiration
absent
weak or irregular
strong
Muscle tone
none
some flexion
active movement
Reflex irritability
no response grimace/feeble cry sneeze/cough/pulls away to stimulation when stimulated when stimulated
Skin color
blue all over blue at extremities
normal
The test is generally done at 1 and 5 minutes after birth, and may be repeated later if the score is, and remains, low. Scores below 3 are generally regarded as critically low, with 4 – 7 fairly low and over 7 generally normal. Low scores at the one minute test may require medical attention, but are not an indication of longer term problems, particularly if there is an improvement by the stage of the five minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer term neurological damage. There is also a small but significant increase in the risk of cerebral palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long–term predictions on a child's health. Some ten years after the initial publication, the acronym APGAR was coined in the US as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. The mnemonic was introduced in 1963 by the pediatrician Dr. Joseph Butterfield. The acronym also exists in German ( Atmung, Puls, Grundtonus, Aussehen, Reflexe ) although here the letters have different meanings.
