APGAR Scores

last authored: Jan 2009, David LaPierre
last reviewed: Oct 2011, Genevieve Dinga-Carr

 

 

Introduction

The Apgar scores, named after Dr Virginia Apgar, are used to determine neonatal health, and are measured at 1 min, 5 min, and reassessed at intervals thereafter if needed. In use since 1953, they remain a relevant predictor of neonatal survial (Casey et al, 2001).

 

 

 

 

 

 

 

 

 

 

 

 

 

Scoring

A full score is 10.

	0	1	2
Heart Rate	none	<100	100-180
Resp Effort	none	poor	good/crying
Irritability	none	grimacing	cough/crying
Tone	none	some flexion	active m ovement
Colour	blue-gray, or pale	centrally pink; blue extremities	fully pink

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Interpretation

Apgar scores were designed to assess response to obstetric anaesthesia, and not identify emergency situations. However, mortality does correlate quite well with Apgar scores; in one study, a five min score of 0-3 was associated with a mortality of 244/1000 infants, compared with 0.2/1000 infants with a score of 7-10 (Casey et al, 2001).

 

Healthy infants are typically receive a score of 8-10, though a full score is rare due to usually peripheral cyanosis (acrocyanosis). They may need some recuscitation, as directed by clinical assessment, but usually do fine on their own.

 

Infants who are in distress will usually receive a score of 6 or less. Given their clinical presentation, for example poor respiratory effort, neonatal recuscitation will have commenced before the Apgar scores are even calculated. As such, calculating an Apgar score is of limited use in an situation where an infant requires recuscitation. In this case, proceed with neonatal recuscitation protocols.

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Resources and References

Casey BM et al. 2001. The continuing value of the Apgar score for the assessment of newborn infants. NEJM. 344(7): 467-471.

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