What’s an APGAR Score?

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An APGAR score is a method for evaluating newborns soon after delivery. APGAR Score tests are fairly easy to administer and are usually done when the newborn is one minute five minutes old. In 1953, medical pioneer Dr. Virginia Apgar developed this scoring method because babies born during that time in hospitals were often partially anesthetized by the sedating drugs given to laboring mothers. The APGAR Score method has also been used to predict which babies might be born with birth defects such as cerebral palsy.

The APGAR Score has ten possible points and evaluates five specific and easily observable areas. APGAR is a mnemonic device for remembering the five areas:
Appearance, pulse, grimace, activity and respiration. Infants can receive up to two points in each area.

For appearance, doctors primarily look to color. A baby who is completely blue at birth, suggesting oxygen deprivation, scores zero points in this category. A pink child with blue ends gets only one point. A completely pink child gets two points.

Pulse refers to the heart rate and can be taken with a stethoscope or by checking the pulse of the carotid artery. It is much easier to check the carotid artery with a newborn than to take a pulse. No pulse scores zero points, pulse below 100 beats per minute (bpm) scores one point, and pulse above 100 bpm scores two points.

The grimace is less easily understood and really results in a reflex reaction in a newborn, which can sometimes be shown on the face. Zero points means the baby is unresponsive to stimulation and one point is awarded for a soft or soft cry. A baby who actively cries or who sneezes and coughs when stimulated gets two points.

Activity refers to limb movement, with zero for no movement, one point for weak movement, and two points for active movement. Breathing is the last APGAR scoring category. Clearly no breath would be awarded zero points. Weak or irregular breathing earns one point, and two points are awarded to a child with strong, even breathing.
Most healthy babies who experience uncomplicated births receive between seven and nine APGAR points. Many hit a ten when they have five minutes. It is not uncommon for a completely healthy newborn to still be eight or nine years old at five minutes. A score of three points or less, especially at the five-minute mark, was thought to be a reliable predictor of cerebral palsy. At the very least, such a score indicates that your child needs immediate medical attention to help with breathing and heart rate regulation. When a child has a very low APGAR score at the five minute mark, a complete blood count (CBC) may be used to help diagnose the problem.

The score is not always a reliable predictor of the birth defects present. In particular, children with very high scores may not show extremely serious conditions such as heart defects, as it may take some time, sometimes several weeks to a month, for such a condition to present itself. With more severe congenital heart defects, the APGAR score may still be normal, but within hours the baby may show signs of severe discomfort or congestive heart failure. Scoring is, on the other hand, a good way to determine an infant’s immediate health and needs and remains a common method of verifying that an infant does not need medical attention.

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