Apgar score

Definition

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother's womb.

In rare cases, the test will be done 10 minutes after birth.

Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.

Alternative Names

Newborn scoring; Delivery - Apgar

How the Test is Performed

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby's:

Each category is scored with 0, 1, or 2, depending on the observed condition.

Breathing effort:

Heart rate is evaluated by stethoscope. This is the most important assessment:

Muscle tone:

Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

Skin color:

Why the Test is Performed

This test is done to determine whether a newborn needs help breathing or is having heart trouble.

Normal Results

The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.

A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.

What Abnormal Results Mean

Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother's womb.

Most of the time a low Apgar score is caused by:

A baby with a low Apgar score may need:

Most of the time, a low score at 1 minute is near-normal by 5 minutes.

A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.

References

Carlo WA. The newborn infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 94.

Hobel CJ, Lamb AR. Fetal surveillance during labor. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 9.



Review Date: 12/9/2016
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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