Apgar test

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.

In recent years there has been some controversy of the relevance and accuracy of some of the criteria used in this test, though many feel it is still an invaluable initial assessment tool particularly where medical services are limited.

Indicator	Score 0	Score 1	Score 2
Activity (muscle tone)	Limp; no movement	Some flexion of arms and legs	Active motion
Pulse (heart rate)	No heart rate	Fewer than 100 beats per minute	At least 100 beats per minute
Grimace (reflex response)	No response to airways being suctioned	Grimace during suctioning	Grimace and pull away, cough, or sneeze during suctioning
Appearance (color)	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 (breathing)	Not breathing	Weak cry; may sound like whimpering, slow or irregular breathing	Good, strong cry; normal rate and effort of breathing

References

• 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. PMID:13083014

Recent Apgar Studies

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. PMID: 11430958

• 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. PMID: 11172187

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