Apgar Score: Assessing Newborn Health, Summaries of Nursing

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What is the Apgar Score?

A simple way to assess the condition of

newborns after birth so care providers will

know which babies need immediate

medical attention.

How is the Apgar Score used?

• 1-minute score tells the birth attendants if the baby

needs special care

• Does the baby need to be resuscitated?
• Does the baby need to be observed more closely?
• This score reflects the state of the baby at birth, not necessarily the long-term health of the baby
• 5-minute score can be more prognostic
• A poor score may be associated with neurologic damage
• May suggest risk of sepsis or hypoglycemia

Scoring

• Assign 0-2 points for the each of the criteria

• Add up points for each 5 criteria to get the

total score

• Maximum is 10; a normal scores is >

• Consistent scoring ensures that the Apgar

can be replicated

Criteria Points

0 1 2

Heart rate none <100 beats/ min

beats/min

Respiratory effort

none Irregular Regular breathing

Muscle tone Limp Moderate Active

Reflex irritability

Silence Whimpering Crying

Color Totally blue Bluish extremities

Pink

Interpretation of Score: 7-10 = Normal; 0-6 = Distress

Limp (Hypotonia) -> Score 0 for Muscle Tone

Feeble cry & grimace when

stimulated -> Score 1 for

Reflex Irritability

Blue feet compared to the rest of the body

-> Score 1 for Color

Interpretation of Score

90% of all neonates will have scores >7 at 1-minute

• Require no further intervention and can receive

routine care -> skin to skin on mother’s abdomen

Scores of <6 require immediate attention ->

resuscitation if indicated

• Repeat score at 5-minute, then 10-minute

intervals if not improved

Case Example #1: At 1-minute a newborn at has a heart beat of 130 beats/min, has regular breathing, he is actively moving his arms and legs, and cries when you dry him off; his body is pink but his feet and hands are blue.

Criteria Score Heart rate 2 Respiratory effort 2 Muscle tone 1 Reflex irritability 1 Color 1 Apgar Score = 7

Case Example #2: At 1-minute a newborn at has a heart beat of 160 beats/min, has regular breathing, she is moving her arms and legs but when you pull her fist, there is little resistance; her cry is minimal in response to stimulation; her body is pink but her feet and hands are blue.

Case Example #3: At 1-minute a newborn at has a heart beat of 110 beats/min, has irregular breathing, she is limp and whimpers when stimulated; her body is blue.

Case Example #3 continued:

After carefully drying her, you help to clear her airway and

stimulate her by rubbing her back. At 5-minutes her heart

beat is 120 beats/min, her breathing is regular, her muscle

tone has increased; she is crying a little; her body is pink

but her feet and hands are blue.

Criteria Score Heart rate 2 Respiratory effort 2 Muscle tone 1 Reflex irritability 1 Color 1 Apgar Score = 7

Case Example #3 continued: After carefully drying her, you help to clear her airway and stimulate her by rubbing her back. At 5-minutes her heart beat is 120 beats/min, her breathing is regular, her muscle tone has increased; she is crying a little; her body is pink but her feet and hands are blue.