What is the Apgar score?

Indications and Procedures

The five categories evaluated by the Apgar score—heart rate, respiratory effort, muscle tone, response to stimulus (reflex response), and color—reflect functions necessary to sustain life. The accompanying table lists the components in descending order of importance. The Apgar score is the sum of scoring (0, 1, or 2) each of the five parameters.

The first Apgar score is traditionally assigned at one minute after birth. It reflects the baby’s condition in the womb and indicates the degree of resuscitation that may be required. A low one-minute score is not predictive of adverse neurologic outcome.

A second Apgar score is assigned at five minutes after birth. A score of 7 to 10 is considered normal, while a score of 4 to 6 is considered borderline. A five-minute Apgar score of 3 or less has been associated with cerebral palsy in full-term infants; however, only approximately 4 to 5 percent of infants with low five-minute Apgar scores have long-term neurologic abnormalities. A stronger relationship exists between low Apgar scores and future neurologic disability when the assessment is taken at times greater than ten minutes after birth.

Perspective and Prospects

Approximately 1.4 percent of all babies have Apgar scores of less than 7 at five minutes after birth. The highest proportions of infants with low Apgar scores at five minutes are among infants born to mothers under sixteen years of age or over forty years of age and to those who did not receive adequate prenatal care.

Current research using the Apgar score focuses increasingly on the neonatal heart rate and respiratory effort, looking for long-term subtle behavioral disabilities that may be associated with low and borderline Apgar scores.

Bibliography

"APGAR." Medline Plus, December 2, 2011.

"Apgar Scores." American Academy of Pediatrics, May 31, 2013.

Apgar, Virginia, and Joan Beck. Is My Baby All Right? New York: Pocket Books, 1974.

Barness, Lewis A. Manual of Pediatric Physical Diagnosis. 6th ed. St. Louis, Mo.: Mosby Medical, 1991.

Schwartz, M. William, et al., eds. Schwartz’s Clinical Handbook of Pediatrics. 5th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2012.

Zitelli, Basil J., and Holly W. Davis, eds. Atlas of Pediatric Physical Diagnosis. 6th ed. St. Louis, Mo.: Mosby/Elsevier, 2012.