APGAR Score
Dr. Virginia Apgar introduced the APGAR scoring system in 1953 to swiftly evaluate a neonate’s adaptation to extra uterine life. The APGAR score translates the newborn’s condition into a numerical value through a rapid post-birth assessment. This approach involves observing crucial indicators: appearance, pulse, grimace (response to stimuli), activity (muscle tone), and respiratory effort.
Healthcare providers conduct the assessment at both 1 minute and 5 minutes following birth, with particular focus on the infant’s heart rate and respiratory effort. Among the observations, these two hold utmost significance. Instances of low APGAR scores are more frequent in cases of high-risk pregnancies and prolonged labour.
In a situation where an infant is in a normal and healthy state at birth, their APGAR score typically falls within the range of 7 to 10. Conversely, if the score is below 7, it signals a certain level of asphyxia or oxygen deprivation, prompting further attention and care from medical professionals.
The acronym APGAR represents the following vital assessment criteria:
- A: Appearance (colour)
- P: Pulse (heart rate)
- G: Grimace (response to stimuli)
- A: Activity (muscle tone)
- R: Respiration (respiratory effort or activity)
Within this scoring framework, the evaluation of heart rate and respiratory efforts involves auscultation. The assessment of muscle tone is achieved by observing the baby’s positioning. Reflex irritability can be gauged through techniques such as stroking the sole of the foot or gently passing a nasal catheter and observing the response. Additionally, careful observation of the body’s colour, as well as the colour of extremities, aids in identifying signs of pallor or cyanosis. Each of these five Apgar indicators is assigned a score of 0, 1, or 2, culminating in a maximum score of 10.
Purpose
The purpose of the APGAR scoring system is to evaluate the condition of a newborn baby rapidly and effectively. Additionally, it aids in facilitating result comparison and standardizing methods of management.
Timing
The assessment is conducted immediately after birth or within one minute. Another assessment is performed after 5 minutes, which holds greater value as it helps in evaluating potential long-term neurological effects. In cases where the score remains notably low at the 5-minute mark, a subsequent evaluation should take place after 15 minutes.
Classification of scoring
The classification of scoring is as follows:
- Severe asphyxia: APGAR score of 0-2.
- Moderate asphyxia: APGAR score of 3-4.
- Mild asphyxia: APGAR score of 5-7.
- No asphyxia: APGAR score of 7-10.
| APGAR SCORE | ||||
| SIGN | 0 POINTS | 1 POINTS | 2 POINTS | |
| A | Appearance | Blue or pale | Blue extremities pink body | Body and extremities pink, no cyanosis |
| P | Pulse | Absent | Below 100 beats per minute | Above 100 beats per minute |
| G | Grimace | No response to stimulation floppy | Grimace on suction or aggressive stimulation | Cry on stimulation |
| A | Activity | None | Some flexion of arms and legs | Active flexion against resistance |
| R | Respiration | absent | Weak, irregular and slow | Strong crying |
Intervention as scoring system
| Intervention as scoring system | |
| Score | Activities |
| 0-3, severe birth asphyxia | Immediate resuscitative procedure |
| 4-6 moderate birth asphyxia | Immediate resuscitative procedure |
| >7 minimal or no asphyxia | No action required |
For more details: Click below
