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The Apgar score is used in assessing the health of a newborn baby. It is named after the American doctor Virginia Apgar, who devised the scoring system and presented it to an anesthetists' conference in Virginia Beach, Virginia in 1952. It has since been adopted widely, certainly in Western countries, and becomes familiar to most mothers after the birth of their baby.
Apgar readings are taken at 1 minute after birth, and again at 5 minutes after birth. In some cases they may be retaken once more at 10 minutes after birth, if the original outcomes have not been favorable but the baby seems to be improving. In each case a score is given out of 10, 0 being the worst outcome and 10 being the most favorable outcome.
'Apgar' is used as a mnemonic to enable doctors to remember the signs they are looking for. These signs are: Activity (or muscle tone), Pulse, Grimace (or reflexes to stimuli), Appearance (or skin colour) and Respiration. Scores are given as follows.
ACTIVITY No movement at all = 0, some flexion of the limbs = 1, active movement = 2
PULSE No pulse = 0, pulse below 100 per minute = 1, pulse over 100 per minute = 2. Occasionally a pulse over 140 is recorded and this is not necessarily a good sign as it may mean that the baby is suffering from heart arrhythmia. However it must be recorded as a 2 on the Apgar score.
GRIMACE No response to stimuli = 0, some response = 1, active response = 2. Urinating is considered to be a good sign, even though it does not occur in response to the stimuli being offered by the physicians.
APPEARANCE All the skin area being blue, grey or very pale = 0, pink skin colour except for the hands and feet = 1, pink all over = 2
RESPIRATION No respiration = 0, slow and irregular respiration = 1, good regular respiration, especially accompanied by crying = 2
Using this scoresheet a score out of 10 is determined. It is common for otherwise healthy babies to score low on the Appearance section as it can take more than five minutes for them to fully pink up. The Apgar score appears on medical records in the format of '1 minute 8, 5 minutes 10'.
The criteria for scoring the Apgar test are easily observed without interfering with the baby too much.
In her 1952 paper presenting her new scoring system, Dr Virginia Apgar stated 'It has been most gratifying to note the enthusiastic interest and competitive spirit displayed by the obstetric house staff who took great pride in a baby with a high score. The same trend of interest has been noted in another hospital which has undertaken the ratings of babies in this manner.' (A Proposal for a New Method of Evaluation on the Newborn Infant, Virginia Apgar, M.D., New York, N.Y. Department of Anesthesiology, Columbia University, College of Physicians and Surgeons and the Anesthesia Service, The Presbyterian Hospital. Presented before the 27th Annual Congress of Anesthetists, Joint Meeting of the International Anesthesia Research Society and the International College of Anesthetists, Virginia Beach, Virginia, September 22-25, 1952).
The Apgar score provides a clearly understood measure of a newborn baby's health. There are many other questions to be asked about the health of the newborn, but this test covers first base at least.
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