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The Apgar score: Baby's first official test
Thanks to a pediatrician named Virginia Apgar, recording a newborn infant’s Apgar score is a daily routine in labor and delivery rooms across the United States and worldwide. In fact, many babies receive this first “official test” before they’ve even been named.
Dr. Apgar, a specialist in anesthesia and childbirth, was extremely interested in the effects of anesthesia given to a mother during labor on her newborn baby. This led her to develop the simple Apgar scoring method in 1952.
“Dr. Apgar had the idea to give babies a score that would convey a sense of how their condition was at birth,” said Julie Luks, M.D., an obstetrician and gynecologist at Marshfield Clinic Weston Center.
The Apgar score became the first standardized method for quick evaluation of a newborn’s health and well-being, and determination of whether extra medical care is needed to help the infant stabilize.
Shortly after the scoring method became standardized, an anonymous physician is said to have remarked, “Every baby born in a modern hospital anywhere in the world is looked at first through the eyes of Virginia Apgar,”
What happens during the Apgar score?
At both one minute and five minutes after a baby’s birth, a physician or nurse looks at five vital areas of the newborn’s health. The five categories are both objective and measurable:
- Appearance (color)
- Pulse (heart rate)
- Grimace (also called reflex irritability)
- Activity (muscle tone)
- Respiration
Dr. Luks explained that the one-minute Apgar score measures how well the newborn tolerated the birthing process, and the five-minute score measures how well it is adapting to the environment. She said some infants are also given a 10-minute score, especially if serious problems exist with the baby’s condition.
“It is generally accepted that the one-minute score has no predictability for the baby’s long-term health, but the five-minute score may have some,” Dr. Luks said.
She added, “It’s important to keep in mind that a lower Apgar score at either interval doesn’t mean that the baby won’t eventually be just fine.”
For example, a baby delivered by cesarean section may have a lower-than-normal Apgar score, especially at the one-minute testing. A low score may also be seen in healthy premature babies, who usually have less muscle tone than full-term newborns. Because of their immature lungs, premature infants may require extra monitoring and breathing assistance.
What do the results mean?
A score of 7-10 is considered normal and means that a newborn is in good condition and doesn’t need more than routine post-delivery care. A score of 10 is extremely unusual as almost all newborns lose one point for bluish-gray coloring in their hands and feet before they have warmed up.
A score less than 7 means the infant needs some assistance; for example, help in breathing. This could mean something as simple as suctioning the infant’s nostrils or it could mean providing oxygen. A baby with a score of 3 or less may need immediate lifesaving measures, such as resuscitation.
“Babies who have a low five-minute Apgar score are more likely to need additional intervention and special care, and perhaps will spend time in the NICU (neonatal intensive care unit),” Dr. Luks said.
Getting early and regular prenatal care is one of the best ways to promote a healthy pregnancy, thus helping to ensure a newborn gets a good start and scores high on the Apgar. Dr. Luk recommends expectant mothers “generally take good care of themselves, don’t smoke while pregnant, eat right, and get good prenatal care.”
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