How Apgar is scored
At one minute and again five minutes after birth, the nurse or a doctor examines the baby and checks her for five different parameters: The baby’s heart rate is counted, breathing is checked, reflexes are assessed, muscle tone is evaluated and the baby’s color is checked. Often there is an alarm clock above the crib making sure these tests are done exactly on time.
Each of these 5 parameters is given a score of between 0 and 2 at 1-minute and 5-minutes after delivery and the scores are added up for the total Apgar score. If you were told that the Apgar score of 7 and 8, for example, the score most likely was 7 at 1 minute and at 5-minutes it was 8.
The lowest total score is 0, the highest score is 10. The 1-minute Apgar score helps to decide whether the baby needs resuscitation or support right after birth. A score from 0-3 usually means that the baby requires support while a score of 7 and above means the baby does not need support. A score of 4-6 means that the decision needs to be individualized. The Apgar score should not be used to decide how the baby is going to do long-term, it's only a short-term measure for the time of birth.
Is the 1-minute or 5-minute Apgar score predictive of a baby with a subsequent problem?
According to the American Academy of Pediatrics, here are some facts:
- The 5-minute Apgar score, and particularly a change in the score between 1 minute and 5 minutes, is a useful index of the response to resuscitation.
- If the Apgar score is less than 7 at 5 minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes.
- A 1-minute Apgar score of 0 to 3 does not predict any individual infant’s outcome.
- A 5-minute Apgar score of 0 to 3 correlates with neonatal mortality in large populations but does not predict individual future neurologic dysfunction.
- Population studies have uniformly reassured us that most infants with low Apgar scores will not develop cerebral palsy.
- However, a low 5-minute Apgar score clearly confers an increased relative risk of cerebral palsy, reported to be as high as 20- to 100-fold over that of infants with a 5-minute Apgar score of 7 to 10.
- Although individual risk varies, the population risk of poor neurologic outcomes also increases when the Apgar score is 3 or less at 10 minutes, 15 minutes, and 20 minutes.
- When a newborn infant has an Apgar score of 5 or less at 5 minutes, umbilical arterial blood gas samples from a clamped section of the umbilical cord should be obtained, if possible.
- Submitting the placenta for pathologic examination may be valuable.