Apgar Score

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is the Apgar score?

Most term infants make a successful and uneventful transition from living within the womb to the outside world. Some will need some medical intervention, and very few will require extensive resuscitation. A reproducible and rapidly determined rating system is necessary for evaluation of the condition of the newborn infant. The Apgar score is a practical method for assessing a neonate.

How is the Apgar score done?

The Apgar score is a number calculated by scoring the heart rate, respiratory effort, muscle tone, skin color, and reflex irritability (response to a catheter in the nostril). Each of these objective signs can receive 0, 1, or 2 points.

What does a high or low Apgar score mean?

A perfect Apgar score of 10 means an infant is in the best possible condition. An infant with an Apgar score of 0-3 needs immediate resuscitation. It is important to note that diligent care of the newborn is an immediate response to the current status of the infant. It is inappropriate to wait until Apgar scores are obtained to begin or continue to address the needs of the neonate.

When is the Apgar scoring done?

The Apgar score is done routinely 60 seconds after the birth of the infant and then is repeated five minutes after birth.

In the event of a difficult resuscitation, the Apgar score may be done again at 10, 15, and 20 minutes.

What does a persistently low Apgar score mean?

The persistence of low (0-3) Apgar scores at 20 minutes of age is predictive of high rates of morbidity (disease) and mortality (death). In term infants, the five-minute Apgar score is predictive of mortality but is not as precise a predictor for neurologic and developmental disabilities. In high-risk (prematurity, low birth weight, etc.) infants, Apgar scores are less sensitive regarding long- term predictions of mental and neurological health.

Why was the Apgar score developed?

The score is named for the preeminent American anesthesiologist Dr. Virginia Apgar (1909-1974), who invented the scoring method in 1952. Having assisted at thousands of deliveries, Dr. Apgar wished to focus attention on the baby. Babies were traditionally dispatched directly to the nursery, often without much formal scrutiny after delivery. Apgar wanted the baby to be assessed in an organized, meaningful manner by the delivery-room personnel. Dr. Apgar was the first woman to be appointed a full professor at Columbia University's College of Physicians and Surgeons.

REFERENCES:

American Academy of Pediatrics. "Use and Abuse of the Apgar Score." Pediatrics 78.6 Dec. 1986: 1148-1149.

Cash, Sheryl. "What's in a Score -- Revised Policy Statement Cautions Against Using the Apgar Score as a Prognostic Tool." AAP News 27.4 Apr. 2006: 1-5.

Iyer, Ravi. "The Apgar Score." Pediatrics 118.3 Sept. 2006: 1314.

Medically Reviewed by a Doctor on 11/16/2015

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