APGAR

Alternative Names
newborn scoring

Definition

The APGAR score is a quick test done on an infant at 1, 5, and sometimes 10 minutes after birth to determine his or her physical condition.

Who is a candidate for the test?

All babies delivered in a hospital or birthing center have APGAR testing by trained delivery room staff. The test is used as a screening tool so doctors can decide what medical help may be needed to stabilize a newborn in distress.

How is the test performed?

The APGAR score is based on looking at five aspects of the infant, first at 1 minute, then again at 5 minutes. If the infant was deemed to be in difficulty during labor and delivery, a 10-minute score may also be performed. Each aspect of the test is scored from 0 to 2 points, depending upon the health of the infant, as follows:

heart rate: 0 = no heart beat; 1 = heart rate less than 100; 2 = heart rate more than 100
respiratory effort: 0 = no breaths; 1 = slow, irregular breathing; 2 = crying with breaths
muscle tone: 0 = flaccid; 1 = some flexion of extremities; 2 = active motion
reflex irritability, which is how much the newborn reacts in response to stimuli: 0 = no response; 1 = grimacing; 2 = vigorous cry
color: 0 = pale blue; 1 = body is pink, but extremities are blue; 2 = body and extremities are pink

What do the test results mean?

The 1-minute APGAR score tells how well the newborn did during labor and the birth process, either for a vaginal or cesarean birth. The 5-minute APGAR score tells how well the newborn adapts to the environment outside the mother's womb. A score of 8 to 10 is ideal, indicating a healthy, vigorous infant. A score of 10 is very rare as most babies' color is a bit blue right after birth, because of the stress of the birth. Any score less than 7 at the 5-minute check indicates that the newborn may need some help in adjusting to the environment. This may include:

continued monitoring and observation in the nursery
continued heart rate monitoring (EKG)
IV fluids
glucose feedings
antibiotics
blood testing
oxygen to the lungs

These infants tend to have lower APGAR scores and possible problems:

premature infants
multiple birth babies, such as twins or triplets
infants with intrauterine growth retardation
newborns deprived of oxygen for a long time during labor

Author:Eva Martin, MD
Date Written:02/24/00
Medical Review:Patti Francis, MD
Date Written:9/21/2006
Reviewer:Reginald Finger, MD
Date Reviewed:9/21/2006
Contributors
Potential conflict of interest information for reviewers available on request