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The Apgar score is a convenient and quick method doctors use to report a newborn’s health just after birth. The test assesses the child’s skin color, pulse rate, reflex irritability grimace, activity, and respiratory effort with a score from zero to two. Low scores on the test show that the infant requires immediate medical care, while high scores show that the child is likely healthy. Doctors usually perform the test at several intervals after birth. These intervals are most commonly one minute and five minutes, though doctors may perform additional tests at 10, 15, and 30 minutes.

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Origin

Anesthesiologist Virginia Apgar created the test in 1952 at the NewYork-Presbyterian Hospital. She devised the test as a way of assessing the infant’s health following the usage of obstetric anesthesia on the mother. Since the test’s creation in 1952, the medical community has adopted a backronym to provide a mnemonic method of remembering each stage of the test. Medical professionals now refer to the five criteria as appearance, pulse, grimace, activity, and respiration.

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Skin Color

The first criteria of the Apgar scoring system test the newborn’s skin color. Doctors look at the skin color itself in lighter-skinned children while they may need to look at the lips, mouth, and tongue of darker-skinned children. A score of zero refers to skin that is blue or pale. A score of one shows the child has acrocyanosis, which is a normal skin tone with blue extremities. Finally, a score of two shows the child has a healthy skin tone all over their body with no signs of cyanosis. Infants will frequently have blue coloration even at the five-minute testing interval, meaning that skin color alone is not an indicator of health.

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Pulse Rate

The second tested criteria of the Apgar system ensures that the child’s heart is functioning correctly. Doctors will measure the child’s pulse and heartbeat with a stethoscope and record the score accordingly. With a score of zero, the pulse rate is completely absent, and the child likely requires resuscitation. One point in this category means that the child’s pulse rate is under 100 beats per minute. Two points mean the child has a healthy pulse rate above 100 beats per minute.

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Reflex Irritability Grimace

The third portion of the Apgar test checks the infant’s reflex irritability or grimace. A nurse or doctor performs this test by lightly slapping the bottom of the infant’s feet or by inserting a catheter into the child’s nose. If the child has no response, the score is zero. The score is one if the child grimaces or shows a small reaction. If the child cries upon stimulation, the person performing the test records the score as two. Professionals consider a sneeze or a cough equal to a vigorous cry and give them a two.

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Muscle Tone

The Apgar test also requires the examination of the infant’s muscles and activity level. Muscles that are loose, floppy, or limp receive a score of zero. A score of one means the muscles have some flexion, but the child is not actively flexing their muscles. A score of two requires the infant to have flexed arms or legs and is resisting any extension of their muscles. If the child is consistently active and moving, doctors will put a two in this category.

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Respiratory Effort

To perform the final test, a medical practitioner will listen to the lungs with a stethoscope to observe the child’s breathing. A zero means the child is putting no effort into breathing. A score of one means the infant has irregular or weak breathing. This score could also mean the child has a weak cry. If the respirations are strong and regular, the score is two. A baby that has a robust cry will receive a two as well.

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Score Interpretation

Apgar scores are not meant to measure neonatal mortality or the potential risk of neurological issues. Low scores at the one-minute interval are common. The primary usage of the one-minute test is to measure a change between fetal and neonatal health. Because of this, medical experts use the five-minute Apgar score as the primary health indicator. A combined score of 10 is uncommon and shows the child is healthy. Additionally, a score lower than seven means the child requires additional tests. Doctors perform these tests every five minutes for up to 20 minutes. If scores remain low, the child likely requires resuscitation.

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Future Health

A low initial Apgar score is not an indicator of future health. The Apgar score shows only how healthy the infant is in the moments after birth. However, infants with low Apgar scores for each testing point after the five-minute interval showed higher risks of neurological disorders such as cerebral palsy. Specifically, the risk increases when the measured Apgar score is three or less at 10, 15, and 20 minutes. Some experts recommend taking a sample of umbilical artery blood gas if the Apgar score is five or lower during the five-minute interval test.

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Limitations

Because numerous factors can affect the Apgar score, it has many limitations. Anesthesia, trauma, and gestational age can all affect the resulting score. The skin tone and reflex irritability categories are somewhat subjective, meaning that different doctors may score the same child differently in these areas. The respiratory category doesn’t necessarily indicate a need for resuscitation or supplemental oxygen. Infants will often show improved oxygen saturation after several minutes, providing a dramatic change of score in that category. Research shows the infant’s weight also affects the scores, with heavier children receiving lower scores.

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Parental Concern

Parents should not be overly concerned with the Apgar scores of their infants. Ultimately, the test only has meaning for the medical professionals performing it, and only at the time, it is performed. Doctors can manage low Apgar scores with resuscitation efforts and additional treatment. Understandably, parents often worry about their child's health and assign more meaning to low Apgar scores than they should. If there is any need for additional testing or medical care, a doctor will provide the necessary information.

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Disclaimer

This site offers information designed for educational purposes only. You should not rely on any information on this site as a substitute for professional medical advice, diagnosis, treatment, or as a substitute for, professional counseling care, advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.