Apgar score

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Virginia Apgar
The Apgar score was devised in 1952 by Dr. Virginia Apgar as a simple and repeatable method
to quickly and summarily assess the health of newborn children immediately after childbirth.[1][2]
Apgar was an anesthesiologist who developed the score in order to ascertain the effects of
obstetric anesthesia on babies.
The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale
from zero to two, then summing up the five values thus obtained. The resulting Apgar score
ranges from zero to 10. The five criteria (Appearance, Pulse, Grimace, Activity, Respiration) are
used as a mnemonic learning aid.

[edit] Criteria
The five criteria of the Apgar score:
Score of 0

Score of 1

blue at extremities
blue or pale all
Skin
body pink
color/Complexion over
(acrocyanosis)
0
<100
Pulse rate
Reflex irritability no response to grimace/feeble cry

Score of 2
no cyanosis
body and
extremities pink
100
cry or pull away

Component of
acronym
Appearance
Pulse
Grimace

Muscle tone
Breathing

stimulation

when stimulated

none

some flexion

absent

weak, irregular,
gasping

when stimulated
flexed arms and
legs that resist
extension
strong, lusty cry

Activity
Respiration

[edit] Interpretation of scores

The test is generally done at one and five minutes after birth, and may be repeated later if the
score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6
fairly low, and 7 to 10 generally normal.
A low score on the one-minute test may show that the neonate requires medical attention[3] but is
not necessarily an indication that there will be long-term problems, particularly if there is an
improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later
times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term
neurological damage. There is also a small but significant increase of the risk of cerebral palsy.
However, the purpose of the Apgar test is to determine quickly whether a newborn needs
immediate medical care; it was not designed to make long-term predictions on a child's health.[1]
A score of 10 is uncommon due to the prevalence of transient cyanosis, and is not substantially
different from a score of 9. Transient cyanosis is common, particularly in babies born at high
altitude. A study comparing babies born in Peru near sea level with babies born at very high
altitude (4340 m) found a significant difference in the first but not the second Apgar score.
Oxygen saturation (see Pulse oximetry) also was lower at high altitude.[4]

[edit] Acronym
Some ten years after the initial publication, the acronym APGAR was coined in the US as a
mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability),
Activity (muscle tone), and Respiration. The same acronym is used in German (Atmung, Puls,
Grundtonus, Aussehen, Reflexe), Spanish (Apariencia, Pulso, Gesticulacin, Actividad,
Respiracin) and French (Apparence, Pouls, Grimace, Activit, Respiration) although the letters
have different meanings.
Another such backformation attempting to make Apgar an acronym is American Pediatric
Gross Assessment Record. The test, however, is named for Dr. Apgar, making Apgar an
eponymous backronym.
The test has also been reformulated with a different mnemonic, How Ready Is This Child, but
the criteria are essentially the same: Heart rate, Respiratory effort, Irritabililty, Tone, and Color.