apgar-score

Apgar score

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. Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on neonates.

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.

Criteria

The five criteria of the Apgar score:
	Score of 0	Score of 1	Score of 2	Component of Acronym
Skin color	blue all over	blue at extremities body pink (acrocyanosis)	no cyanosis body and extremities pink	Appearance
Heart rate	absent	<100	>100	Pulse
Reflex irritability	no response to stimulation	grimace/feeble cry when stimulated	sneeze/cough/pulls away when stimulated	Grimace
Muscle tone	none	some flexion	active movement	Activity
Breathing	absent	weak or irregular	strong	Respiration

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 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.

Contrary to common belief, the Apgar score is no longer used to decide if a neonate requires resuscitation. That decision is based on emergency assessment of airway, breathing, and circulation ("ABC").

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 mnemonic was introduced in 1963 by the pediatrician Dr. Joseph Butterfield. The same acronym is used in German (Atmung, Puls, Grundtonus, Aussehen, Reflexe), Spanish (Apariencia, Pulso, Gesticulación, Actividad, Respiración) and French (Apparence, Pouls, Grimace, Activité et 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.