What Is an Apgar Score?
The Apgar score is a standard neonatal health assessment score that is generally given to babies at one minute and three minutes after birth. The score is based on various assessment components that are designed to measure a newborn's overall health.
The main purpose of the Apgar score is to help doctors determine whether the infant requires medical intervention or assistance. This page will explain the Apgar assessment test and its scoring system to help you better understand how the Apgar score is determined and what it really means.
The Apgar Score is a type of widely utilized neonatal assessment test given to newborns shortly after birth. This test measures how healthy a baby is based off numerous factors, including the baby's appearance, heart rate, reflexes, and other criteria. The goal of the test is to help prevent infant mortality and to determine if immediate medical care is needed.
Again, the test is usually administered at two separate time intervals after birth. The first Apgar test is administered at the 1-minute mark after birth. The results of this test are known as the 1-minute Apgar score. The second test is done 5 minutes after birth and is known as the 5-minute Apgar score. So you typically get a 5-minute Apgar score and a -minute score. If there are concerns about a baby's health and there is a low Apgar score, the test may be given multiple times. In rare or critical cases, the test may be repeated until 10 minutes after birth. You see this more with a preterm birth, an infant that needs resuscitation, and other children at greater risk for neonatal mortality.
The Apgar Score dates back to 1952 when it was first developed by an anesthesiologist named Virginia Apgar, who was studying and quantifying the effects of obstetric anesthesia on newborns. Today the Apgar test and the Apgar scoring system is universally recognized as the standard method of neonatal assessment. Performing 1 minute and 5 minute Apgar tests are standard procedure in labor and delivery rooms across the United States.
Apgar is an acronym that stands for:
- Grimace response
For each category, the newborn baby is ranked from 0-2, with 2 being the highest score. After ranking, the sum of each criteria is added up to determine an overall score between 1 and 10. It is normal for a baby to get a lower score than 10, and does not automatically mean your baby is going to encounter complications.
The doctor will examine the physical appearance of the child, focusing on the skin color of the hands and feet.
- Score of 0: the newborn's body is completely pale or blue in color, no area has become flushed pink
- Score of 1: the body of the newborn has become pink, but the hands and feet remain blue
- Score of 2: the entire body is flushed pink, no area is left discolored or blue
The doctor will use a stethoscope to measure the newborn baby's heart rate. This is generally considered the most important part of the Apgar Score.
- Score of 0: the newborn has no pulse and the heart is not actively beating, immediate and urgent care is required to generate pulse
- Score of 1: newborn has consistent pulse, but is beating less than 100 beats per minute
- Score of 2: newborn's pulse is stable and maintains over 100 beats per minute
The grimace part of the Apgar Score is also known as reflex irritability, which measures a baby's response to stimulation. This part of the test could include the doctor giving the newborn a slight pinch.
- Score of 0: no response to physical stimulation, reflexes are considered floppy and weak
- Score of 1: newborn responds to physical stimulation, but only when that stimulation is aggressive or forceful
- Score of 2: newborn has normal reflexes to physical stimulation, and the child may respond by coughing, sneezing, or crying
The activity score measures a newborn's muscle tone and physical activity of the child. The doctor will extend the arms and legs and watch the newborn flex and move their muscles in response.
- Score of 0: no activity of the arms and legs, newborn does not attempt to move or flex muscles when stimulated
- Score of 1: gives slight movement of arms and legs, but lacks full movement
- Score of 2: actively moves both arms and legs and muscles provide resistance to being overextended
The respiration score measures the newborn's breathing effort after birth.
- Score of 0: newborn is not breathing at all, immediate medical attention is needed to stimulate respiratory system
- Score of 1: newborn is breathing but the breathing is slow, weak, or shallow. The baby is not able to or struggles to cry.
- Score of 2: newborn is taking strong breaths at a regular pace, provides a strong cry after delivery
The final Apgar score is calculated by added up the scores for each of the 5 components of the test. The highest possible total score is 15 and the lowest is 0. Any score higher than 7 is generally considered to be a sign of good health. Many babies get a total score lower than 10 for basically harmless reasons, such as parts of the body taking a longer time to gain color.
If a baby has a low score, it does not necessarily mean they will not grow into a healthy child, but could indicate that they need additional neonatal care. Some babies that have an increased risk of getting a lower score, which include premature babies, C-section deliveries, and babies that had a complicated or traumatic labor and delivery.
In recent years, many doctors have questioned whether the Apgar test is still the best test, arguing that cord blood gasses would be a better test. As a practical matter, some doctor complain that Apgar testing is not reliable and is misused in birth injury lawsuits by trial lawyers. Still, the Apgar test remains the gold standard test for gauging the health of a newborn.
Parents should not immediately worry if their baby receives a low score, especially within the first few minutes after birth. Most babies who receive a low Apgar score will still be healthy and grow properly, even for those who may experience complications. A low score alone does not lead to a prediction of an unhealthy child. And, importantly, if the Apgar raises concern, you are in the right place.
But you may have a reason to be concerned. There is no argument that a low fifth minute Apgar score is strongly associated with the risk of neonatal and infant death. Talk to you healthcare provider. If there any concerns for your baby's health, your doctor will let you know and develop a treatment plan for them. For babies that need additional care, doctors may give the newborn extra oxygen, provide suctioning to the airways, or give physical stimulation to the heart.