What Is the Apgar Score?

The Apgar score is a quick assessment a child receives immediately after birth. This helps the child’s healthcare providers determine if the child needs urgent medical attention.

After entering the world outside the womb, the child must adapt and harmonize with the new conditions. Sometimes, newborn babies may have problems adapting their physical conditions to the environment outside the womb. Diagnosing this lack of adaptation at birth can help the doctor revive and improve the baby’s health conditions and vital signs.

Therefore, after the baby’s birth, the vital signs, which include five important factors, are evaluated and measured by the nurse or midwife to prevent further serious complications. This evaluation is known as the Apgar score or Apgar test. This test is a type of scoring of the baby’s health condition at birth, which can vary between 0 and 10.

Who invented the Apgar score?

The Apgar score was invented by Dr. Virginia Apgar, an American anesthesiologist, in 1952. He designed this simple and quick scoring system to assess the health status of newborns immediately after birth. The main purpose of creating the Apgar score was to identify babies needing urgent medical attention.

What is the Apgar score?

The Apgar score is a quick way for healthcare providers to evaluate the health of all newborns at 1 and 5 minutes after birth. It is based on a score of 1 to 10, with a higher score indicating better health.

Here are the five factors assessed in the Apgar score:

Appearance: Color of the baby’s skin (0-2 points)
Pulse: Heart rate (0-2 points)
Grimace: Reflex response to stimulation (0-2 points)
Activity: Muscle tone (0-2 points)
Respiration: Breathing rate and effort (0-2 points)

A 7, 8, or 9 score is considered normal and a sign that the newborn is healthy. A score of 10 is very unusual since almost all newborns lose 1 point for blue hands and feet, which is normal after birth. If a newborn’s Apgar score is low, it may indicate that the baby needs additional medical attention.

However, it’s important to note that a low Apgar score doesn’t necessarily mean a baby is in serious trouble. Some babies may have low scores due to factors such as prematurity or difficulty during birth, but they may still be healthy and develop normally.

When is the Apgar score done?

The Apgar score is done one minute after the baby’s birth and five minutes after his birth. The one-minute score evaluates how well the baby endured the labor process. The five-minute score tells the baby’s healthcare providers how well the baby is transitioning to life outside the womb. Rarely is the Apgar test also performed 10 minutes after birth. This is only done if the Apgar score is less than 7 in 10 minutes.

Who does the Apgar test?

Healthcare providers such as:

Nurses are often the first to perform the Apgar score in minutes 1 and 5 after birth.
Doctors: pediatricians or obstetricians may also evaluate the baby’s health and perform the Apgar score.

How does the Apgar test work?

The Apgar test is a simple and quick assessment of a newborn’s health. It involves evaluating five key areas:

Appearance: This assesses the baby’s skin color. A baby with pink skin scores 2 points, while a baby with blue skin scores 0 points. A baby who is pale or mottled scores 1 point.
Pulse: This evaluates the baby’s heart rate. A heart rate of over 100 beats per minute scores 2 points, while a heart rate of less than 100 beats per minute scores 1 point. A baby with no heart rate scores 0 points.
Grimace: This assesses the baby’s reflex response to stimulation. A baby who cries or pulls away from a stimulus scores 2 points, while a baby who winces or grimaces scores 1 point. A baby with no response scores 0 points.
Activity: This assesses the baby’s muscle tone. A baby who is active and moves their limbs freely scores 2 points, while a baby who is limp or has weak muscle tone scores 1 point. A baby with no movement scores 0 points.
Respiration: This assesses the baby’s breathing. A baby who is breathing regularly and strongly scores 2 points, while a baby who is breathing slowly or weakly scores 1 point. A baby who is not breathing scores 0 points.

Each of these five areas is scored on a scale of 0 to 2. The total score is then calculated to determine the baby’s overall health. A 7, 8, or 9 score is considered normal and indicates that the baby is healthy. A score of 10 is very unusual, as most babies lose 1 point for blue hands and feet, which is normal after birth. A score of 0 to 3 indicates that the baby needs immediate medical attention.

What happens if the Apgar score is low?

Any score below seven on the Apgar test indicates that the child may need medical attention. The lower this score, the more help the child needs to adapt to life outside the womb. Most low Apgar scores are caused by:

High-risk pregnancy
Premature births
Difficult labor and delivery
Cesarean delivery
Fluid in the child’s airway

If your child has a low Apgar score, it does not mean he will have serious or long-term illnesses. The Apgar score does not mean to predict the child’s future health in any way.

However, immediately after birth, the baby may need:

Suction: The child may need help clearing his airway to help him breathe.
Oxygen: The baby may need oxygen. A mask may be placed over the child’s face to give oxygen. If the child is not breathing on their own within a few minutes, the doctor may insert a tube into the child’s windpipe.
Physical stimulation: Your child’s health care provider may stimulate and dry your baby to get his heart beating regularly.
Other interventions: To help the baby’s heartbeat, they may give the baby fluids and medicines through a blood vessel in his umbilical cord.

With these treatments, most low Apgar scores at one minute on the five-minute Apgar test will be close to normal. If your baby’s Apgar score is still low after these treatments, they’ll be transferred to the neonatal unit for more intensive medical care.

The bottom line

After the baby is born, the medical team will assess the baby’s health. The Apgar score is a quick and easy way to help them determine your child’s health status. But we advise you not to focus too much on your baby’s Apgar score. The Apgar test helps healthcare providers assess a baby’s general physical condition to decide if the baby needs immediate medical attention quickly. It is not meant to predict a baby’s long-term health, behavior, intelligence, personality, or development. Many babies with low Apgar scores need more time to adjust to life outside the womb. Therefore, with the passage of time and receiving the required medical care, most babies will adapt to their new environment and will continue to lead a normal and healthy life.

Additional questions

What is the high-risk score in pregnancy?

A high-risk pregnancy is a pregnancy in which either the mother or the fetus has a higher-than-average chance of experiencing health problems. This can be due to several factors, including:

Maternal health conditions
Pregnancy-related complications
Lifestyle factors
Age
Multiple pregnancies
Previous pregnancy history

What is lung fluid in children?

Fluid in the lungs in children, often known as pulmonary edema, is a serious condition in which excess fluid accumulates in the lungs’ small air sacs. If not treated in time, it can make breathing difficult and even be life-threatening.

What is the cause of pulmonary edema in children?

In most cases, heart problems cause pulmonary edema. However, fluid can accumulate in the lungs for other reasons. These include pneumonia, exposure to certain toxins, medications, trauma to the chest wall, and traveling to or exercising at high altitudes.

What are the five reflexes of a newborn baby?

Babies have several reflexes and involuntary movements that help them survive and adapt to their new environment. Here are five of the most common reflexes: