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What is the APGAR score?

The Apgar test is a test used immediately after the birth of a child. It helps to quickly assess the newborn’s physical condition and the possible need for additional treatment. It was developed in 1952 by anesthesiologist Virginia Apgar. When the child is born, it is necessary to do a test to assess the child’s vitality.  After five minutes, the assessment is repeated once more and again for 10 minutes after birth.

A baby who scores 8 or more on the test is considered in good health. However, a lower score does not mean that your baby is not healthy. This may mean that the baby needs special immediate care, such as oxygen intake through the airway to help her breathe easier.

An Apgar score lower than 7 means your baby may need help. However, keep in mind that a low score one minute after birth does not mean that your baby will not be okay – maybe even a five-minute test.

If the baby scores between 4 and 6 on the first Apgar test, he may need breathing help. It could mean something as simple as sucking his nostrils or massaging, or it could give him oxygen. These measures will likely result in your baby breathing deeper, so his five-minute score will be between 8 and 10.

If the baby scores 3 or less on the first Apgar test, he may need urgent rescue measures, such as resuscitation and intensive care.

What does APGAR stand for?

The test allows healthcare professionals to assess a newborn’s overall condition so that it can be determined very quickly if they need additional medical care. However, the test cannot predict a child’s long-term health, behaviour, intellectual status or personality. If your doctor is concerned about your baby’s outcome, he will explain what could be the cause of the problem and how to deal with it further.

Surname of Virginia Apgar serves as an acronym:

  • Appearance (skin color)
  • Pulse (heart rate)
  • Grimace response (reflexes)
  • Activity (muscle tone)
  • Respiration (breathing rate and effort)

Each characteristic is individually rated from 0 to 2, where 2 is the highest score, so the highest score of the overall test can be 10.

How to calculate APGAR score? APGAR Score Chart

Calculating the total score for Apgar is a two-step process.

First, the health care provider assigns a number from 0 to 2 to describe Apgar’s five “signs,” which include the baby:

  1. Activity: how much does the baby move around
  2. Pulse: how well his heart beats
  3. “Grimace” (responsiveness): how his reflexes act as a reaction to stimulation, like sucking his airways
  4. Appearance: how much color is stained ( which shows that his blood is oxygenated)
  5. Respiration: how well it breathes

Second, the five numbers add up, resulting in a numerical score.

APGAR sign012
Activity (muscle tone)Relaxed, without movement, the muscles are insolent and looseSome muscle tone, some flexion of arms and legsActive, spontaneous movement; crossed arms and legs that provide resistance to extension
Pulse (heart rate)No heartbeatLess than 100 beats per minuteAt least 100 beats per minute
Grimaces (reflexes)There is no response to stimulationFacial grimace during stimulationHe withdraws, coughs, cries loudly or sneezes during stimulation
AppearanceThe whole body is blue or paleGood body color with bluish arms or legsGood color on all sides
Respiration (breathing)Not breathingSlow or irregular breathing, weak crying, whiningNormal breathing speed and effort; good, strong cry
APGAR Score Chart
Illustrative representation of the meaning of the apgar test
Illustrative representation of the meaning of the apgar test

Limitations of APGAR score

In some situations, it is normal to expect a low APGAR:

  • If the birth is well before the term (premature newborns have a lower tone, “immature lungs” which make it difficult for them to breathe;);
  • In the case of childbirth with the use of some of the anesthesia techniques (drugs administered to the mother through the blood reach the fetus, so they can cause mild depression after birth, which can affect the assessment, especially in the first minute);
  • Difficult births (tired newborn) as well as
  • In newborns from high-risk pregnancies.

Newborn birth injuries and the presence of congenital anomalies during childbirth can also affect the value of the assessment.

During pregnancy, the parents mix feelings of happiness and anticipation with worry and anxiety about whether the birth will go without complications, whether the baby will be well at birth, and its further psychomotor development. A high Apgar score at birth for parents means that the baby has successfully overcome its first steps and that there is no risk for its further growth and development.

As mentioned earlier, the Apgar score is not a measure of predicting your baby’s long-term health, behavior, or intelligence.

FAQ

How do you calculate an APGAR score?

The healthcare provider assigns a number from 0 to 2 to describe Apgar’s five “signs”, which include the baby:
1. Activity: how much does the baby move around
2. Pulse: how well his heartbeats
3. “Grimace” (responsiveness): how his reflexes act as a reaction to stimulation, like sucking his airways
4. Appearance: how much color is stained, which shows that his blood is oxygenated
5. Respiration: how well it breathes

Then, the five numbers add up, resulting in a numerical score.

What is a normal APGAR score for a baby?

A score of 7 to 10 is considered normal for the one-minute and five-minute Apgar tests. A result in this range usually means that your baby is in good shape and does not need more than routine postpartum care.

What is a passing APGAR score?

An Apgar score of 4 to 6 means a baby is in fair condition and may require some resuscitation measures.

What does a score of 3 on an APGAR test indicate?

An Apgar score under 4 means a newborn is in poor condition and needs immediate medical attention.

What is a good APGAR score?

Although many babies get a “clean ten”, a small number of babies get a grade of 10 in the fifth minute. A score of 8 or 9 is an excellent grade with the same value as a ten.