Apgar Childbirth Score

The Apgar score is a set of criteria used to evaluate the physical condition of a baby immediately after delivery. This system was first devised in 1952 by Dr. Virginia Apgar as a means of quickly summarizing an infant’s health. Dr. Apgar’s goal was to creat a system that would be simple to use and easily repeated. The Apgar score can be used to determine if a newborn needs emergency care or further medical assistance.

Criteria

Five factors can be added up to equal a newborn’s total Apgar score, including:

• Appearance, such as muscle tone or skin coloration
• Pulse
• Grimace response or reflex irritability
• Activity
• Respiration

This test is typically conducted between one and five minutes after the baby is born and may be repeated if the initial score is considered low. A score of zero to three is regarded as critically low, four to six is moderately low, and seven to ten is considered normal functioning. A score of ten is very rarely achieved but does not differ greatly from a score of nine.

Low Apgar Score Indications

A lower score may indicate that the infant requires medical attention but does not necessarily guarantee the baby will have long-term health issues, as the score may rise during the five-minute test. However, an Apgar score that remains below three during additional testing such as 15 or 30-minute markers is a strong indication that possible long-term neurological damage is present, as well as an increase in the risk of cerebral palsy.

It should be noted that the Apgar test was designed as a means of articulating a child’s immediate medical needs and was not intended to make long-term predictions regarding the baby’s health. External factors such as physiological maturity, medications taken by the mother, and the presence of congenital malformations can influence a baby’s Apgar score.

Neonatal Death Rates

American neonatal death rates associated with five-minute Apgar scores were:

• 0 to 3: 244 per 1,000 in term babies and 315 per 1,000 in preterm babies
• 4 to 6: 9 per 1,000 in term babies and 72 per 1,000 in preterm babies
• 7 to 10: 0.2 per 1,000 in term babies and 5 per 1,000 in preterm babies

Sources:

Apgar, Virginia. “A Proposal for a New Method of Evaluation of the Newborn Infant”. Current Research Anesthesia Analogy. 32.4 (1953): 260–267.

“Use and Abuse of the Apgar Score.” Pediatrics 98.1 (1996): 141. Academic OneFile. Web. 24 May 2012.