From the Guidelines
The APGAR score is a crucial tool for assessing the health of a newborn immediately after birth, evaluating five key criteria: Appearance, Pulse, Grimace, Activity, and Respiration, with scores ranging from 0 to 10. The APGAR score is typically assessed at one minute and five minutes after birth, with additional assessments at later intervals if the score remains low 1. This scoring system is essential for determining if a newborn needs immediate medical attention, as a score of 7-10 indicates a healthy baby, 4-6 suggests moderate distress requiring some intervention, and 0-3 indicates severe distress requiring immediate resuscitation.
Key Components of the APGAR Score
- Appearance (skin color): scored 0,1, or 2
- Pulse (heart rate): scored 0,1, or 2
- Grimace (reflex irritability): scored 0,1, or 2
- Activity (muscle tone): scored 0,1, or 2
- Respiration (breathing effort): scored 0,1, or 2 The APGAR score is affected by various factors, including gestational age, maternal medications, and neurologic conditions, and it is essential to use an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions, as recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists 1. Although the APGAR score does not predict individual mortality or adverse neurologic outcome, 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.
From the Research
Overview of the APGAR Score
- The APGAR score is a widely used tool to evaluate the health of newborn babies immediately after birth 2, 3, 4.
- It is used to assess the need for resuscitation, predict outcomes, and evaluate changes in the condition of the newborn over the first minutes of life 2.
- The score is calculated based on five components: heart rate, respiratory effort, muscle tone, reflex response, and skin color 4.
Reliability and Validity of the APGAR Score
- Studies have shown that the APGAR score has both positive and negative aspects in terms of reliability and validity 3.
- The 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, but available data suggest that serial APGAR ratings can detect clinically important recovery or lack thereof 2.
- There are concerns that the APGAR score may introduce bias into outcomes in both clinical practice and research 3.
Use of the APGAR Score in Clinical Practice and Research
- The APGAR score is no longer used to determine neonatal management in the delivery room 3.
- It is still widely used in research, but its use may introduce bias into outcomes 3.
- There is no consistent definition of a significant APGAR score, and its use can vary depending on the specialty and purpose of the study 5.
- The APGAR score has been correlated with umbilical blood biochemical data, but a severe degree of biochemical disturbance is required to significantly associate with neonatal depression 6.