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What is an APGAR Score?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 27 November 2016
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An APGAR Score is a method for assessing newborns just after delivery. APGAR Score tests are fairly easy to administer and are usually done when the newborn is one minute old and five minutes old. In 1953, medical trailblazer Dr. Virginia Apgar developed this scoring method because children born at this time in hospitals were often partly anesthetized from medication given to sedate laboring mothers. The APGAR Score method was also used to help predict which children might have born with birth defects like cerebral palsy.

The APGAR Score has ten possible points and evaluates five specific and easily observable areas. APGAR is mnemonic device for remembering the five areas: Appearance, Pulse, Grimace, Activity, and Respiration. Infants can receive up to two points in each area.

For Appearance, doctors primarily look at color. An infant that is completely blue at birth, suggesting oxygen deprivation gets zero points in this category. A child that is pink with blue extremities gets a single point. A child that is completely pink gets two points.

Pulse refers to heart rate, and may be taken either with a stethoscope, or by checking the pulse of the carotid artery. It is much easier to check the carotid artery with a newborn, than it is to take a wrist pulse. No pulse earns zero points, pulse under 100 beats per minute (bpm) earns one point and pulse over 100 bpm is worth two points.

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Grimace is less easily understood, and really translates to reflex reaction in a newborn, which can sometimes be shown on the face. Zero points means the infant has no response to stimulation, and one point is given for a weak or feeble cry. A child with an active cry or who sneezes and coughs when stimulated gets two points.

Activity refers to the movement of the limbs, with zero for no movement, one point for weak movement and two points for active movement. Respiration is the last APGAR Score category. Clearly no respiration would be accorded zero points. Weak or irregular breathing earns one point and two points is accorded to a baby with strong and regular breaths.

Most healthy infants that experience uncomplicated births receive APGARs between seven to nine points. Many hit a ten by the time they are five minutes old. It’s not uncommon for a completely healthy newborn to still be at an eight or nine at five minutes old. A score of three points or less, especially at the five-minute mark was thought a reliable predictor for cerebral palsy. At the very least, such a score indicates that the infant is in need of immediate medical support to help with breathing, and regulating heart beat. When an infant has a very low APGAR Score at the five-minute mark, complete blood counts (CBCs) may be used to help diagnose the problem.

The score is not always a reliable predictor for present birth defects. In particular, children with very high scores may not show extremely serious conditions like heart defects, since it may take a while, sometimes several weeks to a month for such a condition to present itself. With the most severe congenital heart defects, APGAR Score may still be normal, but within a few hours the baby may show signs of severe distress or congestive heart failure. The score is, on the other hand, a good way of determining the immediate health and needs of the newborn, and remains a common method for checking to make sure a newborn is not in need of medical assistance.

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