APGAR

Alternative names
Newborn scoring

Definition

The APGAR score is a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn. The rating is based on a scale of 1 to 10. Ten suggests the healthiest infant, and scores below 5 indicate that the infant needs immediate assistance in adjusting to his or her new environment.

The test was designed in 1952 by Dr. Virginia Apgar at Columbia University’s Babies Hospital.

How the test is performed
Five categories are assessed:

     
  • Heart rate  
  • Respiratory effort  
  • Muscle tone  
  • Reflex irritability  
  • Color

Each of these categories is scored with 0, 1 or 2, depending on the observed condition of the newborn.

     
  • Heart rate is evaluated by stethoscope. This is the most important assessment:       o If there is no heartbeat, the infant scores 0 for heart rate.       o If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.       o If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.  
  • Respiratory effort:       o If there are no respirations, the infant scores 0 for respiratory effort.       o If the respirations are slow or irregular, the infant scores 1 for respiratory effort.       o If there is good crying, the infant scores 2 for respiratory effort.  
  • Muscle tone:       o If the muscle tone is flaccid, the infant scores 0 for muscle tone.       o If there is some flexion of the extremities, the infant scores 1 for muscle tone.       o If there is active motion, the infant score 2 for muscle tone.  
  • Reflex irritability is a term describing the level of newborn irritation in response to stimuli (such as a mild pinch):       o If there is no reaction, the infant scores 0 for reflex irritability.       o If there is grimacing, the infant scores 1 for reflex irritability.       o If there is grimacing and a cough, sneeze or a vigorous cry, the infant scores 2 for reflex irritability.  
  • Color:       o If the color is pale blue, the infant scores 0 for color.       o If the body is pink and the extremities are blue, the infant scores 1 for color.       o If the entire body is pink, the infant scores 2 for color.

The 1-minute APGAR score assesses how well the infant tolerated the birthing process. The 5-minute APGAR score assesses how well the newborn is adapting to the environment.

Why the test is performed

This test is a screening tool for health care providers to determine what assistance is immediately necessary to help your newborn stabilize.

Normal Values

A score of 8 or 9 is normal and indicates your newborn is in good condition. A score of 10 is very unusual - almost all newborns lose one point for blue hands and feet.

What abnormal results mean


Any score lower than 8 indicates your child needs assistance stabilizing. A low score at 1 minute that normalizes by 5 minutes has not been associated with any long-term negative effects.

What the risks are

No risks are associated with the APGAR test.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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