The Apgar Score–What It Is and Is Not

The Apgar score was developed in 1952 by New York anesthesiologist Dr. Virginia Apgar. Dr. Apgar was the first woman full professor at Columbia University. She wanted to establish a standardized method for “grading” how well a newborn transitions to life outside the uterus. She chose five signs of newborn well-being that could be easily judged without interfering with its immediate care. Her tool was simple for the hospital staff to learn and did not leave too much room for individual interpretation.

Dr. Apgar’s five criteria include skin color (Apearance), Pulse rate, reflex irritability (Grimace), Activity (muscle tone), and Respiration (breathing). Notice that the bold letters form the word APGAR and have become an acronym for remembering the parts of the assessment. Dr. Apgar’s original study measured the infant’s condition one minute after delivery. The infant was given a score of 0, 1, or 2 for each of the criterion, and then the numbers were totaled. We now assign infants an Apgar score at 5 minutes as well, and continue to record the score at 5-minute intervals up to 20 minutes, if it remains low.

Most healthy babies do not enter the world as howling, kicking little pink bundles. The baby who does is given a 1-minute Apgar score of 10, but that would be extremely unusual. More often, your baby will ease into the world and gradually react to his or her new surroundings over the first few minutes after birth. If your baby is full-term (at least 39 weeks gestation), is breathing easily (whether crying or not), and shows some muscle strength by flexing his or her arms and legs, the transition is going well. Your newborn’s first Apgar score will likely be between 7 and 10, and this is entirely normal. We will deliver your infant immediately to your arms. All that this healthy baby needs in the first few minutes (besides mom) is to be sure his nose and mouth are clear, and to stay warm and dry. For a newborn whose Apgar score is lower, the delivery room staff will support it as needed with suction to clear its airway, stimulation, and sometimes oxygen or other care until it has transitioned successfully.

It is important to understand that an Apgar score (high or low) is not a predictor of future health or development. Research has not shown a consistent relationship between the Apgar score and a child’s later wellness. Five-minute Apgar scores of 4,5, or 6 do not indicate that a child is at higher risk for later neurologic problems. Of course, we are immediately concerned when an infant’s Apgar is very low (0 to 3). The labor, delivery, and pediatric staff will begin emergency care for this infant within the first minute of life. Even in this extreme case, research shows that a full-term infant has only a slightly higher risk of neurological problems. The vast majority of these babies will develop normally. We also know that 75% of children with cerebral palsy had a normal 5-minute Apgar score. The Apgar score can vary widely because many factors influence the birth transition, including maturity (pre-term vs. full-term), medications used during labor, congenital conditions (health problems a baby is born with), and other factors. It is important to understand that the Apgar score only measures well-being in the first few minutes of life. It does not offer clues about future issues like school performance.

So as you cradle your newborn and marvel at his or her fingers and toes, you needn’t worry that you may miss hearing the Apgar score. If you or dad is holding your baby, its transition is going great! There is no “talented and gifted” nursery for little ones who score high on the Apgar test.