What is Normal APGAR Score and APGAR Score Table?

The Apgar score is a medically accepted assessment of a newborns health. Find out more on how the Apgar score is calculated and interpreted.

Last Updated: Oct 22, 2020 11:29 GMT

What is Normal APGAR Score and APGAR Score Table?
What is Normal APGAR Score and APGAR Score Table?

The first few minutes of a newborn life are critical. Closely monitoring the baby soon after birth is important to help act fast on medical interventions, if needed any, in order to save the baby from serious complications.

The Apgar Score
Developed by Dr. Virginia Apgar in 1952, the Apgar score is a medically accepted assessment of a newborn’s health. It includes a set of assessments which are performed by a doctor or a midwife or a nurse, at 1 minute and 5 minutes post birth. The Apgar score includes five elements – color, heart rate, reflexes, muscle tone, and respiration. 
How is the Apgar score calculated? 
At 1 minute and 5 minutes of the baby’s age, the following five assessments are carried out. Each element is then assigned a result value of 0, 1, or 2 according to the following criteria:
Breathing effort
  • If the baby shows no signs of breathing, the score is 0.
  • If the baby is breathing but breathes are slow, irregular, weak or gasping, the score is 1.
  • If the baby is crying vigorously, it indicates normal breathing and the score is 2.
Heart rate
When evaluated with a stethoscope,       
  • If there is no heartbeat, the score is 0.
  • If the heart rate is less than 100 beats per minute, the score is 1.
  • If the heart rate is more than 100 beats per minute, the score is 2.
Muscle tone
  • If the infant shows no movement, the score is 0.
  • If the infant shows some flexion, the score is 1.
  • If the infant is showing an active movement of limbs with good muscle flexion, the score is 2.   
Grimace in response to stimulation
  • If there is no response to stimulation, the score is 0. 
  • If baby makes an expression of grimace in response to stimulation, the score is 1.
  • If baby cries, sneezes or coughs when stimulated, the score is 2. 
Color
  • If the baby’s body is pale or blue in color, the score is 0.
  • If the baby’s body is pink and extremities are blue, the score is 1.
  • If the baby’s body is completely pink, the score is 2. 
How are the Apgar scores interpreted?
In general, when the sum of the five scores, recorded at 1 minute and 5 minutes post birth, equal or is higher than 7, it is a reassuring sign for normal postnatal care for the baby. Scores lower than 7 are indications of additional care. Here is more specific information on interpreting the Apgar score:
  • The first score taken at 1 minute is usually not 10 because babies do not exhibit pink body color within 1 minute of coming out. 
  • The 1-minute score of 7 – 10 is normal.
  • The 1-minute score of 4 – 6 indicates that the baby requires external assistance for breathing like oxygen supply or suctioning of nostrils. 
  • The 1-minute score of 3 or less is a sure sign of emergency resuscitation.
  • A low 1-minute score is necessarily not an indication of long-term health risks as long as the 5-minutes score is normal.
  • A low 5-minutes score may be predictive of increased risk for mortality or cerebral palsy. 
  • When the 5-minutes score is less than 7, recording of the scores is continued for an additional 5 minutes. If the 10-minutes score is less than 5, the risks for neurological complications is higher. 
Limitations of the Apgar score
In spite of its wide acceptance, the Apgar score is not considered to be a reliable assessment of an infant’s health condition, by many doctors for the following reasons:
  • Preterm babies may not score well, especially in the 1-minute recording, because of inadequate growth and maturity. 
  • Babies with congenital abnormalities may show altered Apgar scores. 
  • Apgar scores may also be affected by factors such as cesarean delivery, low birth weight, maternal anesthesia, or complications during delivery. 
  • Apgar scores may carry a slight degree of variability from person to person. If a doctor or nurse was to record the 1-minute score of muscle tone or reflexes, and if another doctor and nurse were to record the 5-minutes score of muscle tone, each may show some variability in their observation. Hence, the Apgar score is considered subjective by some.
References
The Apgar Score. American Academy of Pediatrics Committee on Fetus and Newborn., American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Pediatrics. 2015 Oct; 136(4):819-22.
http://pediatrics.aappublications.org/content/136/4/819.long
Simon LV, Bragg BN. APGAR Score. [Updated 2017 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan.
https://www.ncbi.nlm.nih.gov/books/NBK470569/
Apgar Score: What You Should Know.
https://www.healthline.com/health/apgar-score

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