Apgar Score: Chart, Meaning, & Normal Range

The Apgar assessment is performed immediately after the delivery of the child to see if the newborn is ready to face the world – or needs some help with it. This quick, simple test helps doctors evaluate the infant’s overall health and determine if any immediate interventions are necessary. The assessment focuses on five key factors: heart rate, respiratory effort, muscle tone, reflex response, and skin color. With the help of this assessment, doctors can identify potential complications early, ensuring they can provide immediate relief to the newborn. The infant Apgar score is recorded at one minute and again at five minutes after birth to monitor the baby’s progress.

What Is the Apgar Score?

Wondering what’s the Apgar score definition? The Apgar score of a newborn is one of the first assessments that is administered to a newborn baby immediately after the baby’s birth. Developed in 1952 by an anesthesiologist who goes by the name Virginia Apgar, the score also stands for what it assesses – Appearance, pulse, grimace, activity, and resistance.

Each area is scored separately, with zero being the lowest score, and two being the highest, after which the total score is taken into consideration to assess the newborn’s condition, and whether the child is healthy or in need of medical aid.

If the newborn has a score that ranges between seven to ten, he is said to be healthy and in good shape. This would mean that the child is not in any sort of emergency, and does not require anything more than the regular post-delivery checkup. A score below seven usually means that the child needs to be taken care of. A critically low score below three means that the case becomes a medical emergency and immediate medical care should be administered.

Why Is the Apgar Score Necessary?

The Apgar score happens to be one of the most important assessments that a doctor conducts on a newborn, and there is a good reason for this – to make sure or assess the condition of the baby, in terms of her skin color or appearance, heart rate, reflex, muscles and motor skills, and the breathing rate or respiration. The Apgar test score helps the doctor evaluate the newborn’s condition, and the doctor gets an idea as to whether the baby requires medical treatment now or in the future. All in all, the Apgar score is necessary to check if the newborn baby is hearty.

What Does It Evaluate?

As mentioned before, the Apgar score helps evaluate mainly the normalcy of the newborn, as far as the skin colour, heart rate, reflex, muscles,  motor skills, and the breathing rate is concerned. These five areas will give the doctor a brief understanding of the overall health of the child and will help indicate any complications that the child might face in the future as well.

When Is the Apgar Scoring Assessment Performed?

Apgar scoring is performed twice. The first instance is one minute after birth, and the second is five minutes after birth.

How Is Scoring Done?

Apgar scoring is done immediately after birth to assess the newborn’s health. Here’s how the scoring is done:

1. Appearance

If the baby is pink all over, a score of two is given. Blue extremities but a pink torso mean the child gets a score of one. A child that is pale and blue all over gets no points.

2. Pulse

A healthy child should have a pulse rate that is equal to or slightly greater than 100. This will fetch a score of two on the Apgar score chart. The child gets a score of one if the pulse rate is below 100. If the child has no pulse rate, he gets no points, and immediate medical treatment is given.

3. Grimace

This refers to the reflex or reaction of the newborn when external stimulation is given. The doctor either pinches or hits the newborn child lightly, to see if she reacts or cries.

If the child starts to cry, a score of two is given. A weak cry or grimace will fetch a score of one, and no reaction whatsoever will result in the child getting a zero.

4. Activity

In this area, the child’s activity is assessed. If the child shows signs of movement like flaying of her arms or kicking, she gets a score of two. Light movement gets a score of one, and no movement gets no scoring.

5. Respiration

The newborn’s respiration is assessed, and a score of two is administered if the child cries as soon as he has been delivered, signifying that he is breathing, and the respiration is normal. A feeble cry or gasping will fetch a score of one, while no respiration will get a score of zero.

The scores are then totalled, after which the assessment is made with the help of the Apgar score chart, where a score of zero to three is critically low, four to six is low, and seven to ten is considered normal.

Apgar Score Chart

The Apgar score is a quick and efficient method used by doctors to assess a newborn’s health immediately after birth. The score is based on five criteria, each of which is rated from 0 to 2, with a maximum possible score of 10.

What Does a High or Low Score Mean?

A high score means that the child is healthy, and needs nothing more than the usual medical assistance that is administered right after the delivery of the child.

A low score would mean that the child is in need of medical assistance, and this can be deemed as a case of a medical emergency that needs immediate action. In most of these cases, the child is taken care of immediately and the necessary medical aid is given. The child is kept under medical observation until the condition of the child is stable, and the baby is out of danger.

What Does a Persistently Low Score Mean?

As mentioned before, the Apgar assessment is performed twice – the first one is done immediately after the delivery of the newborn, and the second one is done five minutes after the first assessment. This is done to ensure that the condition of the child is stable and to make sure that any sign of the child’s condition taking a nosedive is taken care of immediately.

If the newborn gets a low score in the first assessment and goes on to get a low score in the second assessment as well, the newborn is said to have a persistently low score indicating that the child is in need of medical assistance.

What Are the Causes of Low Score?

The Apgar score chart shows the five areas that help assess the physical condition of the child – appearance, pulse, grimace, activity, and respiration. The first area deals with the appearance of the child, the second area deals with the pulse rate of the child, the third area deals with the reflex of the child, the fourth area deals with the activity of the child and the fifth area deals with the respiration.

Now, the newborn can get a low score if he has a problem in one, more, or all of the five areas. For example, a newborn child that has a low pulse rate, as well as poor respiration, will most likely fetch a total score of six which is considered a low score that calls for immediate medical assistance.

In some cases, the child gets a low score on the first assessment but scores better on the second assessment. This means that the child is out of danger.

There are many causes of a low score in an Apgar assessment. One of the most leading causes of a low Apgar score is oxygen deprivation or asphyxia. Given below are a few more causes –

1. Trauma during the pregnancy or delivery of the child.
2. Amniotic fluid embolism, where the amniotic fluid enters the mother’s bloodstream, which in turn can cause allergic reactions.
3. Problem with the umbilical cord.
4. When the placenta tears from the uterus due to injury or impact.
5. infections that the mother contracts during the pregnancy.
6. Vaginal bleeding due to injury and other factors.

Is This Score Useful to Predict Future Health Problems?

No. The Apgar score does not predict any future health problems, but is, rather an indication of comfort with which the baby transitions into the world from the womb. Research offers conflicting opinions of the link between a low Apgar score and susceptibility of issues such as cerebral palsy, developmental disorders, and childhood autism, with the faculty at the Turku University Hospital in Finland suggesting that a low Apgar score may hint at these disabilities. However, the link has not been proven conclusively.

FAQ

1. Can an Apgar score change over time?

Yes, the Apgar score can change between the one-minute and five-minute assessments. A baby may initially have a low Apgar score but improve by the five-minute mark if medical interventions are provided promptly. The five-minute score is typically more indicative of the baby’s overall health, as it reflects how the baby is adjusting after birth and receiving necessary care.

While the Apgar score tells the doctor the physical condition of the baby, the results are not permanent. A baby that fetches a low score can get better, this score is used to predict possible health problems. With these scores, you can deal with any complications that the newborn may face.

References/Resources:

1. Apgar Scores; American Academy of Pediatrics; https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Apgar-Scores.aspx

2. What Is the Apgar Score?; Nemours Kids Health; https://kidshealth.org/en/parents/apgar0.html

3. Apgar Score; Cleveland Clinic; https://my.clevelandclinic.org/health/diagnostics/23094-apgar-score

4. The Apgar Score; American College of Obstetricians and Gynecologists Clinical; https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score

5. Baby’s First Assessment: The Apgar Score; Health University of Utah; https://healthcare.utah.edu/healthfeed/2023/01/babys-first-assessment-apgar-score

6. Apgar score; Mount Sinai; https://www.mountsinai.org/health-library/tests/apgar-score

7. Rüdiger. M, Konstantelos. D; Apgar score and risk of cause-specific infant mortality; The Lancet; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60196-9/fulltext; February 2015

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