Apgar Score

Apgar score is the assessment of a newborn baby's physical condition based on skin color, heart rate, response to stimulation, muscle tone, and respiratory effort. Each criteria is rated from zero to two with a total score of 10 signifying the best possible physical condition. The assessment determines the need for immediate emergency treatment, helps prevent unnecessary emergency intervention, and indicates possible brain damage. Because the score corresponds closely to an infant's life expectancy, it is used as a guideline to advise parents on their baby's chances of survival.

Dr. Virginia Apgar published her scoring system in 1953 during her tenure as professor of anesthesiology at Columbia-Presbyterian Medical Center, New York, where she was involved in the birth of more than 17,000 babies. She observed the need for a quick, accurate, scientific evaluation of the newborn, primarily to aid in diagnosing asphyxiation (suffocation) and to determine the need for resuscitation (aided breathing). The evaluations, made and recorded one, five, and ten minutes after birth, quickly became the standard by which modern medicine throughout the world measured the health of the newborn infant.

Apgar's name became an acronym for Appearance, Pulse, Grimace, Activity, and Respiration. Appearance scores two if the baby's skin is a healthy tone such as pink, one if extremities are bluish, and zero if the entire body is blue. Pulse (heart rate) scores two for higher than 100 per minute, one for below 100, and zero if absent. Grimace scores two for an energetic cry (with or without the traditional slap on the bottom or soles of the feet), one for a slight wail, and zero for no response. Actively moving babies score two for muscle tone, one for some effort at movement, and zero if limp. Respiration scores two for strong efforts to breathe; one for irregular breathing, and zero for no effort. With a total five-minute score of seven to 10, the infant's chances of surviving the first month are almost 100%, approximately 80% with a score of four, and 50% with a score of zero to one.

In 1989, an article in The Lancet concluded the Apgar Score was outmoded in light of advanced diagnostic and treatment techniques. Magee Women's Hospital in Pittsburgh, Pennsylvania, the largest obstetrical services hospital in the United States, still uses the Apgar Score as an indicator of the newborn's chances of survival. However, immediate resuscitation needs are determined under the Neonatal Resuscitation Program, developed in 1986 by the American Council of Pediatrics and the American Heart Association, and whose guidelines are used across the United States and by modern medical centers throughout the world.