If the score is below seven at the five-minute mark, the Neonatal Resuscitation Program guidelines specify that the infant's Apgar score should be reassessed at five-minute intervals for up to 20 minutes. Variation between the one-minute and five-minute Apgar scores can be used to assess an infant's response to resuscitation. Therefore, the Apgar score is not used to determine if initial resuscitation is needed, rather it is used to determine if resuscitation efforts should be continued. In cases where a newborn needs resuscitation, it should be initiated before the Apgar score is assigned at the one-minute mark. Transient cyanosis is common, particularly in babies born at high altitude. Ī score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of nine. It is not designed to predict long-term health issues. However, the Apgar test's purpose is to determine quickly whether or not a newborn needs immediate medical care. An Apgar score that remains below three at five minutes and later times, such as 10, 15, or 30 minutes, does not provide supporting evidence for a specific illness but can sometimes be among the first indicators of neonatal encephalopathy. A constellation of factors may contribute to a low Apgar score value. Ī low score on the one-minute mark may show that the neonate requires medical attention, but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute mark. Scores of seven and above are generally normal four to six, fairly low and three and below are generally regarded as critically low and cause for immediate resuscitative efforts. The test is generally done at one and five minutes after birth and may be repeated later if the score is and remains low. Various members of the healthcare team, including midwives, nurses, or physicians, may be involved in the Apgar scoring of a neonate. Interpretation of scores Mind map showing summary for the Apgar score Grimace on suction or aggressive stimulationįlexed arms and legs that resist extension Criteria The five criteria of the Apgar score: Today, the Apgar score is a method of assessment endorsed by the American College of Obstetricians and Gynecologist and the American Academy of Pediatrics. However, today the Apgar score is not utilized as a way to determine the need for newborn resuscitation because supportive measures must be implemented prior to 1 minute after birth. Īs previously mentioned, in its infancy the Apgar score was developed to be used on newborns at 1 minute after birth. Alongside Duncan Holaday and Stanley James, Apgar published a research paper using the scores of 15,348 infants to establish the association between a low Apgar score (0-2) and laboratory findings characteristics of asphyxia. In 1955, efforts to establish a scientific basis to the score increased. In 1952, after some refinement of her initial system, Apgar presented the Apgar score at a joint meeting between the International Anesthesia Research Society (IARS) and the International College of Anesthetist, and it was then published in Anesthesia and Analgesia in 1953. History and development of the Apgar score Īpgar originally thought up the criteria as way to address the lack of a standardized way to assess the need for assistive breathing procedures for newborns.

The list of criteria is a backronym of Apgar's surname.

For each criterion, newborns can receive a score from 0 to 2. The score is determined through the evaluation of the newborn in five criteria: activity (tone), pulse, grimace, appearance, and respiration.

Today, the categories developed by Apgar used to assess the health of a newborn remain largely the same as in 1952, though the way they are implemented and used has evolved over the years. It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar, to address the need for a standardized way to evaluate infants shortly after birth. The Apgar score is a quick way for health professionals to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation. Virginia Apgar, creator of the Apgar score

Low apgar score at birth