The Apgar Score

Abstract

The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. INTRODUCTIONIn 1952, Dr Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing. 1 Dr Apgar subsequently published a second report that included a larger number of patients. 2 This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises 5 components: (1) color; (2) heart rate; (3) reflexes; (4) muscle tone; and (5) respiration. Each of these components is given a score of 0, 1, or 2. Thus, the Apgar score quantitates clinical signs of neonatal depression, such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7. 3 The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if it is needed; however, it has been inappropriately used to predict individual adverse neurologic outcome. of Obstetricians and Gynecologists in collaboration with the American Academy of Pediatrics, along with new guidance on neonatal resuscitation. The guidelines of the Neonatal Resuscitation Program state that the Apgar score is useful for conveying information about the newborn infant's overall status and response to resuscitation. However, resuscitation must be initiated before the 1-minute score is assigned. Therefore, the Apgar score is not used to determine the need for initial resuscitation, what resuscitation steps are necessary, or when to use them. 3 An Apgar score that remains 0 beyond 10 minutes of age may, however, be useful in determining whether continued resuscitative efforts are indicated because very few infants with an Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic outcome. 3,5,6 In line with this outcome, the 2011 Neonatal Resuscitation Program guidelines state that "if you can confirm that no heart rate has been detectable for at least 10 minutes, discontinuation of resuscitative efforts may be appropriate." 3The Neonatal Encephalopathy and Neurologic Outco...

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“…Haakstad & Bø [21] observed higher mean Apgar scores at 1 minute, but not at 5 minutes, among newborns born to women allocated to training in a randomised controlled trial of 105 women. This was observed in a per protocol analysis and not in the intention-to treat analysis, and Apgar score at 5 minutes is considered a better sign of newborn wellbeing than Apgar score at 1 minute [52, 53]. …”

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“…Therefore, the Apgar score offers the opportunity to report the status of the newborn after birth and the response to resuscitation when performed. The Apgar index is a score obtained from the evaluation of 5 parameters (skin colour, tone, heart rate, crying, respiratory activity) for each parameter a score is assigned by the operator [1]. The incidence of low Apgar scores is inversely related to birth weight and gestational age but only a low score cannot predict morbidity or mortality for each individual newborn [2].…”

Effect of antenatal exercise on mode of delivery in gestational diabetic females: a single-blind randomized controlled trial

“…in a randomized controlled trial of 105 women, higher mean Apgar scores were observed at the 1 st minute, but not at the 5 th minute, among newborns of women allocated to training [30]. This was observed in a per-protocol analysis and not in an intention-to-treat analysis, and the Apgar score at the 5 th minute is considered a better sign of newborn wellbeing than that at the 1 st minute [33,34].…”