Understanding
the Apgar Scoring System
Have you ever thought about what the Apgar Score on a newborn
really meant and how it was obtained? The Apgar Score is a
rating system used to evaluate the health of newborn infants.
The test is given one minute and again at five minutes after
birth. A rating of zero, one, or two is given in each of five
categories which include color, breathing, heart rate or pulse,
muscle tone, and response to stimulation. A total score of three
or less is an indication the newborn’s condition is critical
and requires emergency attention. A score of seven or higher
means the newborn’s initial vital statistics are good.
Research on the extended Apgar Score of five minutes, which is
really a recheck, has shown the test to be a fairly reliable
indication that the newborn has a good chance of survival. A
high score does not guarantee that a child’s long term outlook
is completely positive, because the Apgar Score can not check
for all complications.
Physicians had no way to assess the health of a newborn in
the critical first minutes of life until the early 1950s.
Conditions that might have been corrected early sometimes turned
out to be fatal. In 1952, Virginia Apgar, a physician developed
the scoring system that is currently used today for evaluation
of newborns. She spent years studying the effects of anesthesia
in childbirth to develop this system.
Five Components
Five components, each with its own standards, make up the
Apgar Score. The categories and ranges are as follows:
Color: A newborn who has a healthy pink skin tone receives
two points, a pale or bluish skin receives zero points. The
majority of newborns have pink bodies and lips, but bluish color
hands and feet. This color receives one point. A bluish color
all over may mean the newborn has heart or lung problems, an
airway blockage, or has inhaled amniotic fluid.
Breathing: A newborn should gasp or begin to breathe at
birth. Normal breathing gets a score of two, irregular breathing
scores one. Zero is given to a newborn who makes no effort to
breathe. Irregular breathing can mean the newborn lacks oxygen,
has an infection, has central nervous system problems, or has a
depressed respiratory effort because of anesthesia that was
administered to the mother during childbirth.
Pulse: The normal heart rate at birth is between 120 and 160
beats per minute. No detectable heartbeat is scored a zero; less
than 100 beats per minute is scored one; and for a heart rate of
100 beats per minute or more is scored a two.
Muscle tone: The newborn should move his or her arms and legs
at birth. Limpness or poor muscle tone are usually caused by
lack of oxygen, central nervous system trauma, or drugs
administered during childbirth. A limp newborn is scored zero.
Some movement is given a one, and active movement gets a score
of two.
Response to Stimulation: A newborn is stimulated at birth by
inserting a tube through a nostril into the throat. This causes
a cough, grimace, or sneeze. If there is no response, he or she
is scored a zero. A grimace alone gets a one, and a grimace with
cough or sneeze is given a two.
The highest total Apgar Score is ten. It is not unusual for
infants to score a seven at one minute of age and nine or ten at
five minutes of age. At five minutes of age, newborns generally
have healthier skin tone and are breathing normal.
Physicians can take immediate measures if needed to ensure a
newborn’s survival with the information provided by the Apgar
Score. Therefore, a delivery room team should be prepared to
handle a crisis and at least one person who is skilled at
neonatal resuscitation should be present at each delivery. Apgar
Scoring plays a significant role in the assessment of newborns.