Resuscitation should always take precedence over calculating a clinical score.Īpgar scores were designed to help identify infants that require respiratory support or other resuscitative measures, not as an outcome measure. Apgar score alone should not be interpreted as evidence of asphyxia and its significance in outcome studies while widely reported is often inappropriate. It is useful in gauging the response to resuscitation but should not be used to extrapolate outcomes, particularly at 1 minute as this does not hold any long-term clinical significance. Thus, the Apgar score is limited in that it provides somewhat subjective information about an infant’s physiology at a point in time. Several components of the score are also subjective and prone to inter-rater variability. Scores of 7 to 10 are considered reassuring.Īpgar scores may vary with gestational age, birth weight, maternal medications, drug use or anesthesia, and congenital anomalies. The score is recorded at 1 minute and 5 minutes in all infants with expanded recording at 5-minute intervals for infants who score seven or less at 5 minutes, and in those requiring resuscitation as a method for monitoring response. Each element is scored 0 (zero), 1, or 2. Apgar scoring is designed to assess for signs of hemodynamic compromise such as cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression, or apnea. Įlements of the Apgar score include color, heart rate, reflexes, muscle tone, and respiration. While originally designed to assess the need for intervention to establish breathing at 1 minute, the guidelines for the Neonatal Resuscitation Program9NRP) state that Apgar scores do not determine the initial need for intervention as resuscitation must be initiated before the 1-minute Apgar score is assigned. Apgar scoring remains the accepted method of assessment and is endorsed by both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. The score is a rapid method for assessing a neonate immediately after birth and in response to resuscitation. Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar score. This activity reviews the Apgar score and its clinical relevance and highlights the role of the interprofessional team in the evaluation and management of newborns. While originally designed to assess the need for intervention to establish breathing at 1 minute, the guidelines for the Neonatal Resuscitation Program (NRP) state that Apgar scores do not determine the initial need for intervention as resuscitation must be initiated before the 1-minute Apgar score is assigned. Apgar scoring remains the accepted method of assessment and is endorsed by both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). The score is a rapid method for evaluating neonates immediately after birth and in response to resuscitation. Serendipitously, APGAR is also a useful mnemonic to describe the components of the score: appearance, pulse, grimace, activity, and respiration.

Apgar score of 6