Apgar
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 and to determine whether a
newborn needs help breathing or is having heart trouble.
In rare cases, the test will be done 10 minutes after birth.
The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby's:
•Appearance (skin color)
• Pulse (heart rate)
• Grimace response (reflexes)
• Activity (muscle tone)
• Respiration (breathing rate and effort)
Each category is scored with 0, 1, or 2, depending on the observed condition.
Appearance / 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.
Pulse / 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.
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.
Activity/ 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.
Response/ 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.
Normal Results
Normal Results has been expanded.
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
What Abnormal Results Mean has been expanded.
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.
