Apgar is a quick test performed on a baby
at 1 and 5 minutes after birth. The 1-
minute score determines how well the
baby tolerated the birthing process. The
5-minute score tells the health care
provider how well the baby is doing
outside the mother's womb. It also helps
measure how well the baby responds if
resuscitation is needed right after birth.
In rare cases, the test will be done 10
minutes after birth.
HOW IS THE TEST PERFORMED?
• The Apgar test is done by a
doctor, midwife, or nurse. The
health care provider examines
the baby's:
• Breathing effort
• Heart rate
• Muscle tone Each category is scored with 0, 1, or 2,
• Reflexes depending on the observed condition.
• Skin color
A - APPEARANCE OR SKIN COLOR
Skin color:
• If the skin color is pale blue, the infant
scores 0 for color.
• If the body is pink and the extremities
are blue, the infant scores 1 for color.
• If the entire body is pink, the infant
scores 2 for color.
Cyanosis
acrocyanosis Cyanosis can be a blue color around the mouth
or face, or over the whole body. It happens when
the baby’s red blood cells aren't carrying as much
oxygen as expected
P - PULSE
Heart rate is evaluated by stethoscope. This
is the most important assessment:
• If there is no heartbeat, the infant scores
0 for heart rate.
• If heart rate is less than 100 beats per
minute, the infant scores 1 for heart rate.
• If heart rate is greater than 100 beats per
minute, the infant scores 2 for heart rate.
P - PULSE
• Pulse. A newborn’s pulse is
normally 120 to 160 beats per
minute.
• Breathing rate. A newborn’s
breathing rate is normally 40 to 60
breaths per minute.
G - GRIMACE
Grimace response or reflex irritability is a
term describing response to stimulation,
such as a mild pinch:
• If there is no reaction, the infant scores 0
for reflex irritability.
• If there is grimacing, the infant scores 1
for reflex irritability.
• If there is grimacing and a cough, sneeze,
or vigorous cry, the infant scores 2 for
reflex irritability.
A - ACTIVITY
Muscle tone/activity:
• If muscles are loose and floppy, the
infant scores 0 for muscle tone.
• If there is some muscle tone, the infant
scores 1.
• If there is active motion, the infant
scores 2 for muscle tone.
R - RESPIRATION
Breathing effort:
• If the infant is not breathing, the
respiratory score is 0.
• If the respirations are slow or
irregular, the infant scores 1 for
respiratory effort.
• If the infant cries well, the
respiratory score is 2.
What is a normal Apgar score?
Baby’s Apgar score will range from 0 to 10. The higher the
baby’s Apgar score, the better they’re doing after birth.
Most newborns score 7, 8 or 9 on the Apgar test.
A score of 7 or higher is considered a good Apgar score.
Very few newborns score a perfect 10 because it takes a
while for their hands and feet to warm up and turn pink.
About 90% of infants have Apgar scores of 7 to 10.
What happens if the Apgar score is low?
Any score lower than 7 on the Apgar test is a sign that the baby may need
medical attention. The lower the score, the more help your baby needs to
adjust to life outside of the womb. Most low Apgar scores are caused by:
• High-risk pregnancy.
• Premature births.
• Difficult labor and/or delivery.
• Cesarean section (C-section) births.
• Fluid in your baby’s airway.
If the baby has a low Apgar score, it doesn’t mean they’ll have serious or
long-term health conditions.
OTHER INTERVENTIONS
• Suctioning:Your baby may need help clearing their airway to
help them breathe.
• Oxygen: Your baby may need oxygen. A mask may be placed
over your baby’s face to give them oxygen. If your baby isn’t
breathing on their own within a few minutes, their
healthcare provider may place a tube in your baby’s windpipe.
• Physical stimulation: Your baby’s healthcare provider may
stimulate and dry your baby to get their heart beating at a
regular rate.
OTHER INTERVENTIONS
• Other interventions: They may give your baby fluids and
medications through a blood vessel in their umbilical cord to
strengthen their heartbeat as well.
With these treatments, most low Apgar scores at one minute
will be close to normal at the five-minute Apgar test. If your
baby’s Apgar score is still low after these treatments, they’ll be
taken to a special newborn (neonatal) unit for more intensive
medical attention.
A newborn baby girl was delivered at 39 weeks of
gestation. As soon as she was born, the attending
nurse began her assessment. The baby ’s skin
appeared pale with a pinkish hue in her extremities.
The nurse noted that her heart rate was 130 beats
per minute, which is within the normal range.
When the nurse gently flicked the baby’s foot, she
responded with a weak cry and a slight grimace.
The baby displayed some movement in her arms
and legs but was otherwise quite floppy. Her
breathing was irregular, with occasional short, weak
cries.
Task:
[Link] the APGAR score for each criterion based
on the description provided:
Appearance :
Pulse :
Grimace Response :
Activity :
Respiration :
2. Compute the total APGAR
Solution:
Appearance: 1 point (pale with pink extremities)
Pulse: 2 points (heart over 100bpm)
Grimace: 1 point (grimace with weak cry)
Activity: 1 point ( some movement , but overall tone is poor)
Respiration: 1 point (irregular and weak)
Total APGAR Score: 1 + 2 + 1 + 1 + 1 = 6
A baby boy was born at 37 weeks of
gestation. Shortly after delivery, the
nurse assessed his condition. The
baby’s skin was mostly pink, with a
slight bluish tint on his hands and feet.
The heart rate was measured at 90
beats per minute. When the nurse
stimulated the baby by gently rubbing
his back, he responded with a
grimace and a slight cough. The
baby ’s limbs were flexed, but he
showed little movement. His
breathing was slow and irregular,
with a few weak cries.
Task:
[Link] the APGAR score for each criterion based
on the description provided:
Appearance :
Pulse :
Grimace Response :
Activity :
Respiration :
2. Compute the total APGAR