Good apgar score

Apgar score Information | Mount Sinai

Newborn scoring; Delivery - Apgar

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother's womb.

In rare cases, the test will be done 10 minutes after birth.

Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.

An evaluation of the newborn's condition is done immediately after delivery and again at five minutes, to determine the APGAR scores. If some cyanosis (bluish skin) is present, the APGAR scores are lower and oxygen may be administered. The oxygen can often be merely blown by the newborn's face, through the mask in front of the infant.

The newborn is commonly assessed with the APGAR score, a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn. The five categories assessed are heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each of these categories is scored 0, 1, or 2, depending on the observed condition of the newborn.

How the Test is Performed

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby's:

• Breathing effort
• Heart rate
• Muscle tone
• Reflexes
• Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

Breathing effort:

• If the infant is not breathing, the respiratory score is 0.
• If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
• If the infant cries well, the respiratory score is 2.

Heart rate is evaluated by stethoscope. This is the most important assessment:

• If there is no heartbeat, the infant scores 0 for heart rate.
• If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
• If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

Muscle tone:

• If muscles are loose and floppy, the infant scores 0 for muscle tone.
• If there is some muscle tone, the infant scores 1.
• If there is active motion, the infant scores 2 for muscle tone.

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores 0 for reflex irritability.
• If there is grimacing, the infant scores 1 for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

Skin color:

• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.

Why the Test is Performed

This test is done to determine whether a newborn needs help breathing or is having heart trouble.

Normal Results

The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.

A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.

What Abnormal Results Mean

Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother's womb.

Most of the time a low Apgar score is caused by:

• Difficult birth
• C-section
• Fluid in the baby's airway

A baby with a low Apgar score may need:

• Oxygen and clearing out the airway to help with breathing
• Physical stimulation to get the heart beating at a healthy rate

Most of the time, a low score at 1 minute is near-normal by 5 minutes.

A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.

Arulkumaran S. Fetal surveillance in labor. In: Arulkumaran SS, Robson MS, eds. Munro Kerr's Operative Obstetrics. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Goyal NK. The newborn infant. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 113.

Last reviewed on: 10/2/2020

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

What Is the Apgar Score? (for Parents)

What Is the Apgar Score?

The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.

Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born. If there are concerns, a baby may get the test again.

What Does It Check?

The Apgar score measures five things to check a baby's health. Each is scored on a scale of 0 to 2, with 2 being the best score:

1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)

Doctors, midwives, or nurses add up these five factors for the Apgar score. Scores are between 10 and 0. Ten is the highest score possible, but few babies get it. That's because most babies' hands and feet remain blue until they have warmed up.

What Does My Baby's Score Mean?

A baby who scores a 7 or above on the test is considered in good health. A lower score does not mean that your baby is unhealthy. It means that your baby may need some immediate medical care, such as suctioning of the airways or oxygen to help him or her breathe better. Perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.

A slightly low score (especially at 1 minute) is common, especially in babies born:

• after a high-risk pregnancy
• through a C-section
• after a complicated labor and delivery
• early

At 5 minutes after birth, babies get the test again. If a baby's score was low at first and isn't better, or there are other concerns, the doctors and nurses will continue any needed medical care. They'll watch the baby closely.

What if My Baby Has a Low Score?

Many babies with low scores are healthy and do just fine after getting used to life outside the womb.

If your doctor or midwife is concerned about your baby's score, they'll let you know and will explain how your baby is doing, what might be causing problems (if any), and what care is being given.

What Else Should I Know?

This test helps health care providers tell a newborn's overall physical condition so they can quickly decide if a baby needs medical care right away. It isn't meant to predict a baby's long-term health, behavior, intelligence, personality, or outcome.

With time to adjust to their new environment and with any needed medical care, most babies do very well.

Reviewed by: Mary L. Gavin, MD

Date reviewed: February 2018

Apgar score - articles from the specialists of the clinic "Mother and Child"

Severova Maria Sergeevna

Pediatrician

Southwest Mother and Child Clinic

Baby's first assessments

As soon as the baby is born, doctors immediately evaluate his condition and physical development. But not only weight and height are measured for the baby, there are other characteristics by which one can judge how healthy the child is. To do this, use a special scale proposed by the anesthesiologist Virginia Apgar and named after her.

why it is needed

The Apgar score is used to determine which children need more attention. According to this scale, the health status of each newborn is assessed on five indicators: heart rate, respiration, muscle tone, reflexes and skin color of the baby.

The Apgar score, whether it be high or low, is not a diagnosis. This is a signal for the doctor about what measures are now needed or, conversely, the child does not need. Depending on the results of the assessment, an additional examination may be prescribed: blood tests, urine tests, a study for intrauterine infections, ultrasound, neurosonography. And after that, it is decided what to do next - to observe or treat the child.

how to test

During examination, each symptom (heart rate, respiration, muscle tone, reflexes, and skin color) is given 0, 1, or 2 points. A score of 2 points in the delivery room is considered the highest and means that the sign is pronounced, 1 point - weakly expressed, 0 points - the sign is absent. The child is evaluated on the Apgar scale at the 1st and 5th minutes of life, so there are always two scores, for example, 8/9 points or 9/10 points. Children rarely score the maximum 10 points in the first minute of life, and usually the first score is always lower than the second. But the second assessment can just be equal to 10 points.

evaluation criteria

counting points

Children who score between 7 and 10 are considered to be in good condition and usually require only routine care. Those who score between 4 and 6 are in fair condition and may only need some resuscitation. Immediate life-saving assistance is needed for those who score below 4.

let's be objective

In general, the Apgar score, although it is set according to objective criteria, still does not give an absolutely accurate forecast of the child's health in the future. It cannot be unequivocally said that a newborn who was given a 9or 10 Apgar scores, healthier than someone who got only 7 points. This only means that in the first case the baby breathes normally, he has pink skin and mucous membranes, he screams loudly enough, he has well-defined reflexes. And in the second case, one or two signs are less pronounced: for example, in the first minute the skin of the extremities is bluish, not pink, because the circulatory system takes about 5 minutes to get it working, or a healthy newborn loses points because he screams quietly in the first minutes life.

what is important

As already mentioned, the first Apgar score is always lower than the second. In most newborns, the condition 1 minute after birth is estimated at 7-8 points on the Apgar scale, and after 5 minutes - at 8-10 points. And this suggests that the child was born in a satisfactory (normal) condition. If the Apgar score at the 1st minute is low, then the positive dynamics by the 5th minute will be important. If the points increase by 2 or more by the 5th minute, then most likely the prognosis for health will be favorable. If, 5 minutes after birth, the Apgar score does not exceed 6 points, it will be necessary to conduct intensive therapy or continue resuscitation. So the main task of the Apgar scale is a quick assessment of whether a child needs medical help and how much.

Whatever the Apgar score, the development of a child largely depends on love, care and upbringing in the family. So parental attention will always help the baby achieve the highest marks in life!

Children rarely score the maximum 10 points in the first minute of life, and usually the first score is always lower than the second. But the second assessment can just be equal to 10 points

With a low Apgar score at the 1st minute of a baby’s life, positive dynamics is extremely important - an increase of 2 or more points by the 5th minute of life

Most newborns have an Apgar score of 7–8 1 minute after birth, and 8–10 Apgar scores 5 minutes later

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A neonatologist from St.

The Apgar scale is a system for assessing the condition of a newborn (as doctors say, “clinical status”) in the first minutes of life. It was proposed by the American anesthesiologist Virginia Apgar almost 70 years ago, but remains relevant to this day.

In essence, the Apgar scale shows whether a newly born baby needs medical help here and now. The peculiarity of such screening is that it does not require any special equipment - the assessment is given, as they say, "by eye", quickly and accurately.

The scale consists of 5 blocks:

• skin color
• heart rate
• reflex excitability (reaction to external stimuli)
• muscle tone
• breath

Doctors assess the child's condition twice - at the end of the first and fifth minutes of life, so the points obtained are written through a slash 6/7 or 8/9. According to Larisa Fedorova, a neonatologist at St. Petersburg State Pediatric Medical University, 7 points and more fall within the normal range. At the same time, it is desirable that the second assessment be higher than the first, because after birth, the child does not immediately adapt to a new world for himself. Positive dynamics is important.

Why do doctors take into account the first 5 minutes of life, and not 7 or 10, when assessing the Apgar scale? According to the neonatologist, studies have shown that this time period is most informative in relation to the outcome: if, with an initially serious condition of the newborn, after 5 minutes it was not possible to improve the performance, complications or even death may develop. According to the doctor, the Apgar scale alone is not enough to fully assess the severity of the condition of the newborn.