In the early 1950's Virginia Apgar published the research article that was the basis of a simple diagnostic test, the 10-point Apgar score, for neonatal well-being at birth that continues to be used today.
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Apgar Score Sheet |
Virginia Apgar with neonate (Images NLM) |
While in recent years there has been some controversy of the relevance and accuracy of some of the criteria used in this test, it is still an invaluable initial assessment tool.
The test is carried out at one and five minutes after birth. Additional tests are repeated later later if these initial scores are low.
Page Links: Introduction | Some Recent Findings | Virgina Apgar | APGAR Test | Recent Apgar Studies | References | Glossary
Hellstrom-Westas L, Forsblad K, Sjors G, Saugstad OD, Bjorklund LJ, Marsal K, Kallen K. Earlier Apgar score increase in severely depressed term infants cared for in Swedish level III units with 40% oxygen versus 100% oxygen resuscitation strategies: a population-based register study. Pediatrics. 2006 Dec;118(6):e1798-804.
"Severely depressed term infants born in hospitals initiating resuscitation with 40% oxygen had earlier Apgar score recovery than did infants born in hospitals using a 100% oxygen strategy."
O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. J Pediatr. 2006 Oct;149(4):486-9.
"The Apgar score has poor interobserver reliability. More objective and precise measures of newborns' condition are required."
Keenan W. The Apgar challenge. J Pediatr. 2006 Oct;149(4):440.
"Virginia Apgar’s most enduring contribution is the Apgar score for neonatal assessment, which is used in virtually every country in the world. ... the sustained value of the Apgar score requires improved reliability, confrontation of sources of variance, unequivocal performance expectations, better training, and investment in quality control."
Virginia Apgar with neonate (Image NLM)
Virginia Apgar (1909-1974) classic research article appeared in Current Researches in Anesthesia and Analgesia in 1953 and is the basis of the Apgar test that continues to be used today. She subsequently published more than 40 papers in this field.
In 1959, the National Foundation March of Dimes offered her the position of chief of the Division of Congenital Malformations and she continued her association with this foundation with until her death.
Virginia Apgar U.S. Postage stamps
In 1994, she was honoured with on commemorative U.S. postage stamp.
Apgar, V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7.
Links: National Library of Medicine - The Virginia Apgar Papers | March of Dimes | March of Dimes Milestones and Timeline | News - History
Measured at one and five minutes after birth the Score values are totalled for all indicators: 7-10 is considered normal, 4-7 may require resuscitative measures, 3 and below require immediate resuscitation.
Indicator |
Score 0 |
Score 1 |
Score 2 |
Activity |
Limp; no movement |
Some flexion of arms and legs |
Active motion |
Pulse |
No heart rate |
Fewer than 100 beats per minute |
At least 100 beats per minute |
Grimace |
No response to airways being suctioned |
Grimace during suctioning |
Grimace and pull away, cough, or sneeze during suctioning |
Appearance |
The baby's whole body is completely bluish-gray or pale |
Good color in body with bluish hands or feet |
Good color all over |
Respiration |
Not breathing |
Weak cry; may sound like whimpering, slow or irregular breathing |
Good, strong cry; normal rate and effort of breathing |
Recently two large neonatal studies have examined whether the Apgar score is still a relevant neonatal assessment tool.
Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol. 2001 Jul;98(1):65-70.
Casey BM, McIntire DD, Leveno KJ The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001 Feb 15;344(7):467-71.
Links: Reviews | Articles | Online Textbooks | Search Textbooks | Search PubMed | Glossary
Bharti B, Bharti S. A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings. J Clin Epidemiol. 2005 Feb;58(2):121-9.
Leuthner SR, Das UG. Low Apgar scores and the definition of birth asphyxia. Pediatr Clin North Am. 2004 Jun;51(3):737-45.
Juretschke LJ. Apgar scoring: its use and meaning for today's newborn. Neonatal Netw. 2000 Feb;19(1):17-9.
Articles
Apgar, V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7.
Hellstrom-Westas L, Forsblad K, Sjors G, Saugstad OD, Bjorklund LJ, Marsal K, Kallen K. Earlier Apgar score increase in severely depressed term infants cared for in Swedish level III units with 40% oxygen versus 100% oxygen resuscitation strategies: a population-based register study. Pediatrics. 2006 Dec;118(6):e1798-804.
O'Donnell CP, Kamlin CO, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. J Pediatr. 2006 Oct;149(4):486-9.
Keenan W. The Apgar challenge. J Pediatr. 2006 Oct;149(4):440.
Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol. 2001 Jul;98(1):65-70.
Casey BM, McIntire DD, Leveno KJ The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001 Feb 15;344(7):467-71.
Search PubMed: Jan 2007 "Apgar" 8,872 reference articles of which 327 were reviews.
Search PubMed Now: term = Apgar | author = Virginia Apgar
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Page under development (notice removed when complete)
This page introduces concepts related to the Apgar test at birth as a diagnostic tool and should give you a feel for the topic.
These notes should be considered in relation to Neonatal Development.
Please email Dr Mark Hill if you wish to make a comment about this current project.