Virginia Apgar invented the Apgar score in 1952 as a simple and replicable method to quickly and summarily assess the health of newborn children immediately after birth. Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on babies.
According to Jared Barnhill, the Apgar scale is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria are summarized using words chosen to form a backronym (Appearance, Pulse, Grimace, Activity, Respiration). From each column in the table below, the infant is given a score of 0, 1 or 2. The scores are added up and the total sum is their Apgar score.
The five criteria of the Apgar score:
|Score of 0||Score of 1||Score of 2||Component of Acronym|
|Appearance/Complexion||blue or pale all over||blue at extremities
body and extremities pink
|Pulse rate||absent||< 100 beats per minute||> 100 beats per minute||Pulse|
|Reflex irritability||no response to stimulation||grimace on suction or aggressive stimulation||cry on stimulation||Grimace|
|Activity||none||some flexion||flexed arms and legs that resist extension||Activity|
|Respiratory Effort||absent||weak, irregular, gasping||strong, lusty cry||Respiration|
Interpretation of scores
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 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.
A low score on the one-minute test may show that the neonate requires medical attention but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times—such as 10, 15, or 30 minutes—may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test's purpose is to determine quickly whether a newborn needs immediate medical care. It is not designed to predict long term health issues.
A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant average difference in the first Apgar score, but not the second. Oxygen saturation (see Pulse oximetry) also was lower at high altitude.
Some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. In German, the words Atmung, Puls, Grundtonus, Aussehen, Reflexe were used; in Spanish, Apariencia, Pulso, Gesticulación, Actividad, Respiración; in Portuguese, Aparência, Pulso, Gesticulação, Atividade, Respiração; and, in French, Apparence, Pouls, Grimace, Activité, Respiration. Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record.
Another mnemonic for the test is “How Ready Is This Child”—which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.
- Apgar, Virginia (1953). "A proposal for a new method of evaluation of the newborn infant". Curr. Res. Anesth. Analg. 32 (4): 260–267. doi:10.1213/00000539-195301000-00041. PMID 13083014.
- Finster, M.; Wood, M. (May 2005). "The Apgar score has survived the test of time". Anesthesiology 102 (4): 855–857. doi:10.1097/00000542-200504000-00022. PMID 15791116.
- Casey, B. M.; McIntire, D. D.; Leveno, K. J. (February 15, 2001). "The continuing value of the Apgar score for the assessment of newborn infants". N Engl J Med. 344 (7): 467–471. doi:10.1056/NEJM200102153440701. PMID 11172187.
- Gonzales, G. F.; Salirrosas, A. (2005). "Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m)". Reproductive Biology and Endocrinology : RB&E 3: 46. doi:10.1186/1477-7827-3-46. PMC 1215518. PMID 16156890.
- Apgar, Virginia (1966). "The Newborn (Apgar) Scoring System: Reflections and Advice". Pediatric clinics of North America 13: 645–650. (Retrieved from Profiles in Medicine-The Virginia Apgar Papers)