The Apgar Score

What is an Apgar score?

An Apgar score is a quick way for caregivers to see how your newborn is doing right after birth. A newborn's Apgar score is checked at one minute and five minutes after birth. The newborn's Apgar score may also be checked at 10 minutes, and even up to 20 minutes after birth. Newborns are checked for A ppearance (skin color), P ulse (heartbeat), G rimace (reflexes), A ctivity (muscles), and R espirations (breathing).

When is an Apgar score used?

The Apgar score describes the health of a newborn right after birth. Caregivers use the Apgar score to help guide them in caring for the newborn right after birth. The score tells caregivers if a newborn needs special care, such as extra oxygen.

How is the Apgar score used?

When caregivers check your newborn, they look at the parts of the test below, and give each part a score between zero and two. The Apgar score is the total of these numbers. The lowest score is zero and the highest score is 10.

  • Appearance: This part of the test checks a newborn's skin color:

    • 0 - Your newborn's skin is pale or blue all over.

    • 1 - Your newborn's body is pink, but his hands and feet are blue.

    • 2 - Your newborn's body, hands, and feet are all pink.

  • Pulse: This part of the test checks a newborn's heartbeat:

    • 0 - Your newborn has no heartbeat.

    • 1 - Your newborn's heartbeat is less than 100 beats per minute.

    • 2 - Your newborn's heartbeat is more than 100 beats per minute.

  • Grimace: This part of the test checks a newborn's reaction to pain, such as rubbing the bottom of his feet:

    • 0 - Your newborn does not react to pain.

    • 1 - Your newborn frowns but does not move his hand or foot away from pain.

    • 2 - Your newborn has a strong cry and pulls his hand or foot away from pain.

  • Activity: This part of the test checks a newborn's muscles:

    • 0 - Your newborn has limp (weak) muscles.

    • 1 - Your newborn has some movement in his arms and legs.

    • 2 - Your newborn moves his arms and legs a lot.

  • Respiration: This part of the test checks how fast, how deep, and how strong a newborn is breathing:

    • 0 - Your newborn is not breathing.

    • 1 - Your newborn has slow, weak breaths that are not regular.

    • 2 - Your newborn has a strong cry and takes full breaths.

What are the limitations of the Apgar score?

  • One caregiver may not give the same Apgar score to a newborn as another caregiver. Your newborn may need other tests to learn about his health now and in the future. The Apgar score may be low if your newborn was born premature (earlier than expected). The Apgar score is useful for caregivers if a newborn has a low birth weight, between 3.3 and 5.5 pounds (1500 to 2499 grams). The Apgar score may not be as helpful to caregivers for newborns with very low birth weights, below 3.3 pounds (1500 grams).

  • Problems during pregnancy, such as an infection or injury from a fall, may cause a low Apgar score. Your newborn's Apgar score may be low if you took certain medicines or were dehydrated while having your baby (during labor and delivery). Dehydration is a lack of body fluids, such as water. Your newborn's Apgar score may be low if he had trouble breathing right after he was born. If your newborn had a medical problem during pregnancy, he may have a low Apgar score.

What other tests may be used with the Apgar score?

Your caregiver finds out how many weeks you were pregnant when you give birth. Your caregiver weighs your newborn right after birth. The doctor may test the blood in your newborn's umbilical cord. This is the cord that connects an unborn baby to the placenta (nutrient supplier) inside your body. For more information about other tests, ask your newborn's caregiver.

What does a high Apgar score mean for my newborn baby?

A newborn with an Apgar score of seven or higher is often healthy. This means that the newborn is pink, crying, moving his arms and legs, and has a regular heartbeat.

What does a low Apgar score mean for my newborn baby?

  • Caregivers will need to watch your newborn closely. Your newborn may need to have more tests. Newborn babies with a score of less than seven may have problems after birth. Newborn babies with a score of less than four or five have a greater risk of having serious problems. Newborns who are born too early may have low Apgar scores. Babies with weak muscles or lungs that are not fully formed may also have low Apgar scores. If your newborn had problems during pregnancy, he may have a low Apgar score.

  • Newborns with low Apgar scores may not be able to hear as well as other children. Babies who had low Apgar scores are more likely to have epilepsy as children and adults. Epilepsy is a serious brain condition that can cause seizures. Children who had low Apgar scores may have trouble learning in school as they grow older. Talk with your newborn's caregivers about your newborn's Apgar score.

Where can I find more information about Apgar scores?

  • American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village , IL 60007-1098
    Phone: 1- 847 - 434-4000
    Web Address: http://www.aap.org

Care Agreement

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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