Apgar

Apgar

Alternate Names

  • newborn scoring

Definition

The APGAR score is a quick test done on an infant at 1, 5, and sometimes 10 minutes after birth to determine his or her physical condition.

Who is a candidate for the test?

All babies delivered in a hospital or birthing center have APGAR testing by trained delivery room staff. The test is used as a screening tool so doctors can decide what medical help may be needed to stabilize a newborn in distress.

How is the test performed?

The APGAR score is based on looking at five aspects of the infant, first at 1 minute, then again at 5 minutes. If the infant was deemed to be in difficulty during labor and delivery, a 10-minute score may also be performed. Each aspect of the test is scored from 0 to 2 points, depending upon the health of the infant, as follows:
  • heart rate: 0 = no heart beat; 1 = heart rate less than 100; 2 = heart rate more than 100
  • respiratory effort: 0 = no breaths; 1 = slow, irregular breathing; 2 = crying with breaths
  • muscle tone: 0 = flaccid; 1 = some flexion of extremities; 2 = active motion
  • reflex irritability, which is how much the newborn reacts in response to stimuli: 0 = no response; 1 = grimacing; 2 = vigorous cry
  • color: 0 = pale blue; 1 = body is pink, but extremities are blue; 2 = body and extremities are pink

What do the test results mean?

The 1-minute APGAR score tells how well the newborn did during labor and the birth process, either for a vaginal or cesarean birth. The 5-minute APGAR score tells how well the newborn adapts to the environment outside the mother's womb. A score of 8 to 10 is ideal, indicating a healthy, vigorous infant. A score of 10 is very rare as most babies' color is a bit blue right after birth, because of the stress of the birth. Any score less than 7 at the 5-minute check indicates that the newborn may need some help in adjusting to the environment. This may include:
  • continued monitoring and observation in the nursery
  • continued heart rate monitoring (EKG)
  • IV fluids
  • glucose feedings
  • antibiotics
  • blood testing
  • oxygen to the lungs
These infants tend to have lower APGAR scores and possible problems:
  • premature infants
  • multiple birth babies, such as twins or triplets
  • infants with intrauterine growth retardation
  • newborns deprived of oxygen for a long time during labor

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