Apgar score

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Virginia Apgar

Virginia Apgar devised the Apgar score in 1952 as a simple and replicable method to quickly and summarily assess the health of newborn children immediately after birth.[1][2] Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on babies.

The Apgar scale 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 are summarized using words chosen to form a backronym (Appearance, Pulse, Grimace, Activity, Respiration). From each column in the table below, the infant is given a score of 0, 1 or 2. The scores are added up and the total sum is their Apgar score.


The five criteria of the Apgar score:

Score of 0Score of 1Score of 2Component of Acronym
Appearance/Complexionblue or pale all overblue at extremities
body pink
no cyanosis
body and extremities pink
Pulse rateabsent<100>100Pulse
Reflex irritabilityno response to stimulationgrimace/feeble cry when stimulatedcry or pull away when stimulatedGrimace
Activitynonesome flexionflexed arms and legs that resist extensionActivity
Respiratory Effortabsentweak, irregular, gaspingstrong, lusty cryRespiration

Interpretation of scores[edit]

Mind map showing summary for the Apgar score

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 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.

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]


Some ten years after the initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. In German, the words Atmung, Puls, Grundtonus, Aussehen, Reflexe were used; in Spanish, Apariencia, Pulso, Gesticulación, Actividad, Respiración; in Portuguese, Aparência, Pulso, Gesticulação, Atividade, Respiração; and, in French, Apparence, Pouls, Grimace, Activité, Respiration.

Another case where Apgar's name is eponymous for a backronym is American Pediatric Gross Assessment Record.

Another mnemonic devised for the test is to use the phrase “How Ready Is This Child”, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.

See also[edit]


  1. ^ a b Apgar, Virginia (1953). "A proposal for a new method of evaluation of the newborn infant". Curr. Res. Anesth. Analg. 32 (4): 260–267. PMID 13083014. 
  2. ^ Finster, M.; Wood, M. (May 2005). "The Apgar score has survived the test of time". Anesthesiology 102 (4): 855–857. doi:10.1097/00000542-200504000-00022. PMID 15791116. 
  3. ^ Casey, B. M.; McIntire, D. D.; Leveno, K. J. (February 15, 2001). "The continuing value of the Apgar score for the assessment of newborn infants". N Engl J Med. 344 (7): 467–471. doi:10.1056/NEJM200102153440701. PMID 11172187. 
  4. ^ Gonzales, G. F.; Salirrosas, A. (2005). "Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m)". Reproductive Biology and Endocrinology : RB&E 3: 46. doi:10.1186/1477-7827-3-46. PMC 1215518. PMID 16156890. 

Further reading[edit]