What is the APGAR Score?
The APGAR Score, developed in 1952 by Dr. Virginia Apgar, is a standardized tool designed to quickly evaluate the health of newborns immediately after birth. It assesses five critical criteria that reflect the baby’s overall condition and the need for urgent medical attention.
The APGAR score ranges from 0 to 10 points, with each criterion scored from 0 to 2 points:
- 7–10 points: Healthy and stable (Reassuring).
- 4–6 points: Moderately abnormal, may require intervention.
- 0–3 points: Low score, indicating critical health concerns and the need for immediate resuscitation.
This evaluation is conducted at 1 minute and 5 minutes after birth. Babies scoring below 7 at 5 minutes are reassessed at 10, 15, and 20 minutes postpartum to monitor improvement or deterioration. A score of 5 or less at 5 minutes typically requires additional diagnostic testing, such as umbilical artery blood gas analysis.
What Does APGAR Stand For?
The acronym APGAR was created to simplify memorization of the five assessment criteria:
- A – Appearance: Evaluates skin color.
- P – Pulse: Measures heart rate.
- G – Grimace: Assesses reflex irritability and response to stimuli.
- A – Activity: Observes muscle tone and movements.
- R – Respiration: Checks the strength and quality of breathing and crying.
Alternative Mnemonic:
Another way to remember the APGAR components is through the phrase:
"How Ready Is This Child?"
- H – Heart rate
- R – Respiratory effort
- I – Irritability (Reflexes)
- T – Tone (Muscle Activity)
- C – Color (Skin Appearance)
How to Calculate the APGAR Score?
Each of the five characteristics is scored from 0 to 2, based on specific criteria:
| Characteristic |
0 Points |
1 Point |
2 Point |
| Skin Color (Appearance) |
Pale or blue all over |
Pink body, blue extremities |
Pink all over |
| Heart Rate (Pulse) |
Absent |
Below 100 bpm |
Over 100 bpm |
| Reflex Irritability (Grimace) |
No response |
Grimace or weak response |
Cry or strong response |
| Muscle Tone (Activity) |
Limp |
Some flexion of arms/legs |
Active motion and good muscle tone |
| Respiration |
Absent |
Weak or irregular breathing, weak cry |
Strong cry, regular breathing |
The total score is calculated by summing the points from all five categories. A higher score typically indicates better newborn health.
Why is the APGAR Score Important?
- Quick Diagnosis: Assists healthcare providers in determining whether immediate medical care or resuscitation is required.
- Monitoring Resuscitation Effects: Helps track the effectiveness of interventions. For example, an improved score at 5 minutes compared to 1 minute suggests positive response to care.
- Universal Standard: Provides a consistent and widely understood way to evaluate newborn health across hospitals and medical teams.
- Parent Education: Allows parents to understand their baby’s condition in simple terms.
Limitations of the APGAR Score
While useful, the APGAR score has certain limitations:
- Influenced by external factors: Premature birth, maternal medications, or resuscitation efforts may affect the score
- Not diagnostic for specific conditions: Cannot independently diagnose conditions like asphyxia or predict long-term health outcomes.
- Subjectivity: Some criteria (e.g., reflex irritability) rely on subjective judgment, which may vary between professionals.
The APGAR score should be used alongside other clinical evaluations and diagnostic tests for comprehensive newborn care.