What is the purpose of using Apgar (Appearance, Pulse, Grimace, Activity, Respiration) scores if they do not predict future outcomes or guide therapy?

From the Guidelines

Apgar scores are used primarily as a standardized tool to assess a newborn's immediate condition at birth and to determine if resuscitation efforts are needed, not to predict long-term outcomes. The score evaluates five parameters (Appearance, Pulse, Grimace, Activity, and Respiration) at one and five minutes after birth, providing healthcare providers with a quick, objective assessment of how well the baby is transitioning to extrauterine life. According to a study published in Pediatrics in 2015 1, Apgar scores do not predict individual mortality or adverse neurologic outcome, but they can indicate an increased relative risk of cerebral palsy when the score is less than 5 at 5 and 10 minutes.

The value of Apgar scoring lies in its simplicity and universal application, allowing for consistent evaluation of newborns across different settings. Some key points to consider when using Apgar scores include:

• They provide a mechanism to record fetal-to-neonatal transition
• They are affected by many factors, including gestational age, maternal medications, and neurologic conditions
• Perinatal health care professionals should be consistent in assigning an Apgar score during resuscitation
• 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, as noted in the 2015 study 1.

Additionally, the scores serve as a common language for healthcare providers to communicate about a newborn's initial status and document the effectiveness of any resuscitation efforts. Despite their limitations in predicting long-term outcomes, Apgar scores remain valuable for their original purpose: providing a rapid assessment tool during the critical first minutes of life when timely interventions can be lifesaving.

From the Research

Purpose of Apgar Scores

• The Apgar score is widely used for several purposes: to discriminate between infants who require resuscitation at birth and those who do not; to predict outcome; and to evaluate change in the condition of the newly born over the first minutes of life 2.
• Despite its limitations, the Apgar score remains the best tool for the identification of newly born infants in need of cardiopulmonary resuscitation 2.

Limitations of Apgar Scores

• The Apgar score is insensitive but fairly specific for predicting later death or handicap 2.
• The ability of the Apgar score to measure change over time has not been studied systematically 2.
• The Apgar score is no longer used to determine neonatal management in the delivery room 3.
• The use of the Apgar score in research may introduce bias into outcomes 3.

Predictive Ability of Apgar Scores

• A 10-minute Apgar score of 0 alone does not predict the risk of death or moderate or severe disability well 4.
• The predictive accuracy of the Apgar score improves when combined with other risk variables available during resuscitation 4.
• The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia 5.

Clinical Use of Apgar Scores

• The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation 5.
• An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care 5.
• The duration of resuscitation should be tailored to the setting, and the focus in low-resource settings should be improving the quality of antenatal and immediately after birth care 6.