The Apgar Score

Introduced in 1952 by Dr. Virginia Apgar, the “Apgar score” is a means of evaluating whether babies need help breathing or are having heart problems at the time of birth. The score was designed for health care providers to assess quickly and easily which babies may need some support. The first score is given at 1 minute of life, which tells doctors how well the baby handled the actual birthing process. The second score is given at 5 minutes of life, and reflects how well the baby is transitioning to being outside the mother’s body. In rare instances, a third score is performed at 10 minutes of life (most often this is done if the first two scores are low).

Five categories are assessed and given a score of 0, 1 or 2 depending on the observed condition: 
  • Breathing effort
  • Heart rate
  • Muscle tone
  • Reflexes
  • Skin color

For example, an infant who is not breathing would receive a score of 0 for that component, while a baby who has a strong cry would receive a 2, and so forth for each condition. The higher the total score, the better the baby is adapting to its new environment. A score of 7, 8, or 9 is the most common and is considered normal. A score of 10 is very rare due to the fact that almost all babies have blue hands and feet at birth and lose a point for skin color. A score less than 7 is an indicator that the baby needs some help, whether it be breathing support, oxygen, removal of secretions from the airway, stimulation to get the baby to cry or grimace, or even CPR to help with a slow heart rate. Babies with low Apgar scores at 1 minute of life are very often normal by 5 minutes of life, especially with proper intervention. The most common causes of low Apgar scores are a difficult birth, cesarean delivery and fluid in the baby’s airway.

The most important thing to remember about Apgar scores is that they do not in any way predict a baby’s overall health, and a low Apgar score at birth does not mean the baby will have long-term health problems. It is merely meant to be a rapid assessment for health care providers to determine when babies need assistance at birth. Health care providers know that time is of the essence to take care of a struggling newborn, and this score is simply meant to promote rapid assessment and intervention.

Susan Benson, MD, FACOG, is the Regional Medical Director of St. Vincent Medical Group Primary Care and the Department Head of Obstetrics and Gynecology at St. Vincent Fishers Hospital. Her office is located at St. Vincent Fishers Hospital (317.415.6450) and she is currently accepting new patients.

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