WHAT IS AN APGAR SCORE?

Written by Caroline Meyer

The Apgar score is a system that is used when babies are born after being assessed by a doctor or nurse. This is usually done at one minute and again at five minutes after birth. The system was originally created in 1952 by Dr. Virginia Apgar, for whom the scoring system is named. She used her own last name as a mnemonic for the five categories that are assessed. This scoring system is used internationally to assess infants all over the world.

WHAT DOES APGAR STAND FOR?

Apgar stands for: Appearance, Pulse, Grimace, Activity, and Respiration. These are the five categories that are assessed and are scored on a scale of zero to two. This means the baby can score from 0 to 10 on the Apgar scale. Appearance is based on the colour of the baby at one minute and five minutes after birth. The pulse is the heart rate.  The Grimace response refers to the baby’s reflexes. Activity looks at muscle tone, while Respiration refers to the effort and rate of breathing. Most babies do not score a perfect 10 because their feet and hands may stay blue for a while after birth until they have warmed up.

A low Apgar score may indicate that the baby might require special attention. The Apgar score may be announced in the labour room.  This gives the medical professionals in the room a good idea of the baby’s condition immediately after birth. Babies with a low Apgar may need assistance with breathing or to be put on a heart monitor for example. A score of 7 and above usually indicates that the baby is in good health. A lower score does not automatically indicate a problem but it may mean the baby requires additional medical care straight away. This can be as simple as suctioning the airways or giving the new-born oxygen to help them breathe easier. Some babies may be perfectly healthy even after having a score of under 7 at the time of their birth.

Appearance (colour):                     0 for bluish-grey, blue or very pale 

                                                            1 for pink body but blue hands and feet

                                                            2 for pink all over

Pulse/heart rate:                                0 is there is no heart rate

                                                             1 heart rate is under 100 beats a minute

                                                             2 heart rate is over 100 beats per minute

Grimace (stimulation response) :    0 is for no response

                                                             1 grimacing or other facial movement when stimulated

                                                             2 sneeze/cough/cry or pull feet away when stimulated

Activity and muscle tone:             0 floppy or limp

                                                            1 limbs are flexed

                                                            2 displays active movement

Respiration (breathing):                 0 no breathing

                                                            1 breathing is irregular / crying weakly

                                                            2 regular breathing / strong cry

Scores are often lower at one minute but increase after 5 minutes when there has been some intervention. This allows the doctors to determine if the baby has improved after initial interventions as well.  Some babies are a lot more likely to have lower Apgar scores at birth. These include: babies born via Caesarean, premature babies, babies born after a complicated delivery.

WHAT IS A NORMAL APGAR SCORE?

A score of 7 to 10 after five minutes is considered the general norm.  A score of 4 to 6 is considered to be moderately abnormal and may need further intervention. A score of 0 to 3 is usually indicates a need for increased intervention. This is often assistance for breathing. The baby may be transferred to an intensive care unit and will often be dried off vigorously and oxygen will be given to try and improve respiration. If the Apgar score is particularly low and there are concerns for the baby’s health, your doctor or nurse will usually explain what the issue is and the interventions that are being done to improve the situation.

The Apgar scoring system is by no means a perfect system. Many doctors will use a Combined Apgar scoring system. This will indicate the score as well as the interventions taken. A Combined Apgar will score out of 17. A score of 17 means a perfect Apgar and no interventions were taken. A score of 0 means that there was no response to any of the interventions taken.

While the Apgar is a useful measuring tool for the caregivers when baby has just been born, it does not necessarily have a long term impact on the potential health of your baby. It is also quite subjective and the scores given by 2 different people may not always be exactly the same.  So even if your new-born does not score 10 out 10 at 1 minute after birth, they may still go on to be perfectly healthy, happy infants.