From the Guidelines
Apgar scores are used primarily as a standardized assessment tool to evaluate a newborn's immediate condition at birth and to determine if immediate medical intervention is needed, despite not being predictive of long-term outcomes or guiding ongoing therapy. The score provides a quick, systematic way to assess five key physiological parameters (heart rate, respiratory effort, muscle tone, reflex irritability, and color) at one and five minutes after birth, creating a universal language for healthcare providers to communicate about a newborn's transition to extrauterine life 1. While low Apgar scores may indicate the need for resuscitation efforts, they serve mainly as a snapshot of the infant's status at that specific moment rather than as a prognostic tool. Some key points to consider when using Apgar scores include:
- 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 1
- 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 1
- 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 1 The value of Apgar scoring lies in its simplicity, universality, and ability to identify infants requiring immediate attention, though additional assessments are necessary for determining long-term care plans or predicting developmental outcomes. Healthcare providers should view Apgar scores as one component of a comprehensive newborn assessment rather than as the sole determinant of clinical decisions beyond the immediate post-birth period.
From the Research
Use of Apgar Scores
- The Apgar score is widely used for several purposes, including 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.
- The Apgar score is insensitive but fairly specific for predicting later death or handicap 2.
Limitations of Apgar Scores
- 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.
- There is no consistent definition of a significant Apgar score, with 50 different definitions found in published studies 4.
Clinical Use of Apgar Scores
- The Apgar score is used to assess newborn status after pregnancy/delivery interventions, and to identify infants with a poor prognosis 4, 5.
- Apgar scores, heart rate, and other variables can be used for early identification of infants with a poor prognosis 5.
- A 10-minute Apgar score of 0 alone does not predict the risk of death or moderate or severe disability well, but can be combined with other risk variables to improve predictive accuracy 6.