APGAR Score

The first test given to your newborn, the APGAR, occurs right after your baby's birth in the delivery room or birthing room. The test was designed to quickly evaluate a newborn's physical condition to determine any immediate need for extra medical or emergency care.

The APGAR score was devised by Virginia Apgar, in 1952, as a simple and repeatable method to quickly and summarily assess the health of a child immediately after childbirth.

The Apgar score sometimes is used as an acronym for: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

The APGAR score is determined by evaluating a newborn baby on each of five criteria on a scale from zero to two and summing up the five values.  The resulting Apgar score ranges from zero to 10.

The test is usually given to a newborn twice, once at 1 minute after birth and again at 5 minutes after birth. Rarely, if there are serious problems with 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.

Scores below 3 are generally regarded as critically low, with 4 to 7 fairly low and over 7 generally normal.  Low scores at the one minute test may suggest medical attention. 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 problems.  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

The five factors evaluated are:

• heart rate (pulse)
• breathing (rate and effort)
• activity and muscle tone
• grimace response (medically known as "reflex irritability")
• appearance (skin coloration)

The following has been adapted from Kids Health.

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. For example, a score between 4 and 6 at 1 minute indicates 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, 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 healthy 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.