The Apgar Score in Babies

Dr. Parang Mehta, MD.

The Apgar score was devised by an anesthetist, Dr. Virginia Apgar, in 1952. Sixty years later, it is still an excellent tool for its original purpose -- to assess a baby's vitality at time of birth, and to estimate the possibility of a complicated post natal period for the baby.

Uses of the Apgar Score

However, for this last purpose it has been found to be unreliable. Some babies with very low Apgar scores at one and five minutes go on to be neurologically normal in later childhood. On the other hand, babies with nearly normal Apgar scores turn out to have significant neurological deficits as they grow up.

This is hardly surprising, however. Dr Apgar had never meant the scoring system to be used for predicting long term outcome. It fails in this use, because it assesses only the biophysical status of the baby at the time of birth. Brain damage, or lack of it, depends on the conditions for some hours, days, or weeks before the actual time of delivery.

The Apgar score does have some predictive ability, of course. Apgar scores of 7-10 are considered normal, and such babies rarely have cerebral palsy or other neurological deficits. On the othere hand, babies with Apgar scores of 3 or less have 80 times the probability of some brain damage. More than 90% of babies with Apgar scores of zero to three will be normal in later life. The problem is, the Apgar score is not reliably predictive for an individual baby.

Failings of the Apgar Score

It is not good at predicting later cerebral palsy and other neurological defects. It's not alone -- none of the many tests used in newborns reliably predict later neurological status.

It gives low scores to premature newborns who are in good health. This is because premature newborns naturally have poor muscle tone and reflex stimulation. Respiratory efforts are often less vigorous than term infants.

Today, an asphyxiated baby is intubated soon after birth, and given assisted respiration. This confounds the Apgar system.

Last Revision: February 15, 2016

The Scoring System

The Apgar score consists of five components. Each of these is given a score of 0, 1, or 2. Put together, the score obtained is an indicator of the baby's physical condition and vitality at that moment. The five components are:

Traditionally, the baby is assessed by the Apgar score at 60 seconds (one minute) and 5 minutes after birth. The maximum score attainable by a baby is 10/10.

Some babies are born asphyxiated -- they do not breathe and cry after birth. Depending on the Apgar score, decisions are made about medication, oxygen administration, heart support and artificial respiration to be given to such babies.

Contact Information

Dr. Parang Mehta,
Mehta Childcare,
Opposite Putli, Sagrampura,
Surat, India.     Tel: +91 9429486624.