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APGAR

Definition

APGAR is a quick test performed at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score assesses how well the newborn is adapting to the new environment.

The rating is based on a total score of 1 to 10, with 10 suggesting the healthiest infant. Scores below 5 indicate that the infant needs immediate assistance in adjusting to his or her new environment.

Alternative Names

Newborn scoring

How the test is performed

Five categories are assessed:

• Breathing effort
• Heart rate
• Muscle tone
• Reflexes
• Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

• Breathing effort:
  • If the infant is not breathing, the respiratory score is 0.
  • If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
  • If the infant cries well, the respiratory score is 2.
• Heart rate is evaluated by stethoscope. This is the most important assessment:
  • If there is no heartbeat, the infant scores 0 for heart rate.
  • If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
  • If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.
• Muscle tone:
  • If muscles are loose and floppy, the infant scores 0 for muscle tone.
  • If there is some muscle tone, the infant scores 1.
  • If there is active motion, the infant scores 2 for muscle tone.
• Reflex irritability is a term describing response to stimulation such as a mild pinch:
  • If there is no reaction, the infant scores 0 for reflex irritability.
  • If there is grimacing, the infant scores 1 for reflex irritability.
  • If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.
• Skin color:
  • If the skin color is pale blue, the infant scores 0 for color.
  • If the body is pink and the extremities are blue, the infant scores 1 for color.
  • If the entire body is pink, the infant scores 2 for color.

Why the test is performed

This test is a screening tool to determine whether a newborn needs help stabilizing.

Normal Values

A score of 8 or 9 is normal and indicates the newborn is in good condition. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for the transitional phase after birth.

What abnormal results mean

Any score lower than 8 indicates the child needs assistance. However, a child who has a low score at 1 minute and a normal score at 5 minutes should not have any long-term problems.

What the risks are

The APGAR test has no risks. It is very safe.

Review Date:11/14/2007
Reviewed By:Deirdre O’Reilly, M.D., M.P.H., Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts.

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