APGAR Score Record-Infant

APGAR Score Record-Infant

APGAR Score Record

Summary of Recommendation and Evidence

Population

Recommendation

Grade
(What's This?)

Screening of both Genders

This screening is recommended a best practice.

B

What is APGAR score?

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother's womb.

In rare cases, the test will be done 10 minutes after birth.

Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.

When is the APGAR test used?

The APGAR is used immediately following the delivery of a baby. Test scores are recorded at one minute and five minutes from the time of birth.

Why Is The APGAR Test Necessary?

The one minute APGAR assessment provides information about the baby’s physical health, and helps the physician determine if immediate or future medical treatment will be required. The five minute assessment measures how the baby has responded to previous resuscitation attempts, if such attempts were made.

What Conditions Does The APGAR Test Evaluate?

APGAR measures the baby’s color, heart rate, reflexes, muscle tone and respiratory effort.

What Do The APGAR Scores Mean?

APGAR scores range from zero to two for each condition with a maximum final total score of ten. At the one minute APGAR, scores between seven and ten indicate that the baby will need only routine post delivery care.  Scores between four and six indicate that some assistance for breathing might be required. Scores under four can call for prompt, lifesaving measures.

At the five minute APGAR, a score of seven to ten is normal. If the score falls below seven, the baby will continue to be monitored and retested every five minutes for up to twenty minutes. Lower than normal scores do not mean that there will be permanent health problems with the child.

Criteria for APGAR Score

The five criteria of the APGAR Score:

Score of 0

Score of 1

Score of 2

Component of backronym

Skin color

blue or pale all over

blue at extremities
body pink
(acrocyanosis)

nocyanosis
body and extremities pink

Appearance

Pulse rate

absent

<100 beats per minute

>100 beats per minute

Pulse

Reflexirritability grimace

no response to stimulation

grimace on suction or aggressive stimulation

cry on stimulation

Grimace

 Activity

none

someflexion

flexed arms and legs that resist extension

Activity

Respiratory effort

absent

weak, irregular, gasping

strong, robust cry

Respiration

 

How the Test is Performed

The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby's:

  • 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.

Grimace response or 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 done to determine whether a newborn needs help breathing or is having heart trouble.

Normal Results

The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.

A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.

What Abnormal Results Mean

Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother's womb.

Most of the time a low Apgar score is caused by:

  • Difficult birth
  • C-section
  • Fluid in the baby's airway 

A baby with a low Apgar score may need:

  • Oxygen and clearing out the airway to help with breathing
  • Physical stimulation to get the heart beating at a healthy rate 

Most of the time, a low score at 1 minute is near-normal by 5 minutes.

A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.