Apgar score is a method to quickly summarize the health of newborn children. Dr. Virginia Apgar, an anesthesiologist at NewYorkâ€"Presbyterian Hospital, developed the score in 1952 in order to quantify 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).
Criteria
The five criteria of the Apgar score:
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 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 but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later timesâ€"such as 10, 15, or 30 minutesâ€"may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test's purpose is to determine quickly whether a newborn needs immediate medical care. It is not designed to predict long term health issues.
A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant average difference in the first Apgar score, but not the second. Oxygen saturation (see Pulse oximetry) also was lower at high altitude.
Backronym
Some ten years after 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.
Spanish: Apariencia, Pulso, Gesticulación, Actividad, Respiración;
Portuguese: Aparência, Pulso, Gesticulação, Atividade, Respiração;
French: Apparence, Pouls, Grimace, Activité, Respiration;
German: Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order (respiration, pulse, muscle tone, appearance, reflex).
Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record.
Another mnemonic for the test is “How Ready Is This Child?†â€" which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.
See also
- Ballard Maturational Assessment
- Bishop score
- Glasgow Coma Scale
- Paediatric Glasgow Coma Scale
References
Further reading
- Apgar, Virginia (1966). "The Newborn (Apgar) Scoring System: Reflections and Advice" (PDF). Pediatric clinics of North America. 13: 645â€"650. (Retrieved from Profiles in Medicine-The Virginia Apgar Papers)