APGAR

• Alternative Names

  Newborn scoring

• How the test is performed

  The APGAR test is done by a doctor, midwife, or nurse. The health care provider will examine the baby's:

  • Breathing effort
  • Heart rate
  • Muscle tone
  • Reflexes
  • Skin color

  Each category is scored with 0, 1, or 2, depending on the observed condition.

  • Breathing effort:
    • If the infant is not breathing, the respiratory score is 0.
    • If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
    • If the infant cries well, the respiratory score is 2.
  • Heart rate is evaluated by stethoscope. This is the most important assessment:
    • If there is no heartbeat, the infant scores 0 for heart rate.
    • If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
    • If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.
  • Muscle tone:
    • If muscles are loose and floppy, the infant scores 0 for muscle tone.
    • If there is some muscle tone, the infant scores 1.
    • If there is active motion, the infant scores 2 for muscle tone.
  • Grimace response or reflex irritability is a term describing response to stimulation such as a mild pinch:
    • If there is no reaction, the infant scores 0 for reflex irritability.
    • If there is grimacing, the infant scores 1 for reflex irritability.
    • If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.
  • Skin color:
    • If the skin color is pale blue, the infant scores 0 for color.
    • If the body is pink and the extremities are blue, the infant scores 1 for color.
    • If the entire body is pink, the infant scores 2 for color.
• Why the test is performed

  This test is a screening tool to determine whether a newborn needs medical attention to stabilize the heart or breathing function.

• Normal Values

  A score of 8 or 9 is normal and indicates the newborn is in good condition. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for the transitional phase after birth.

• What abnormal results mean

  Any score lower than 8 indicates the child needs assistance. Scores below 5 indicate that the infant needs immediate assistance in adjusting to his or her new environment. However, a child who has a low score at 1 minute and a normal score at 5 minutes should not have any long-term problems.

• What the risks are

  The APGAR test has no risks. It is very safe.

Review Date: 11/30/2009

Reviewed By: Deirdre O’Reilly, M.D., M.P.H., Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts.