In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


In 1952, Dr. Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar score. The score is a rapid method for assessing a neonate immediately after birth and in response to resuscitation. Apgar scoring remains the accepted method of assessment and is endorsed by both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. While originally designed to assess the need for intervention to establish breathing at 1 minute, the guidelines for the Neonatal Resuscitation Program9NRP) state that Apgar scores do not determine the initial need for intervention as resuscitation must be initiated before the 1-minute Apgar score is assigned.

Elements of the Apgar score include color, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise such as cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression, or apnea. Each element is scored 0 (zero), 1, or 2. The score is recorded at 1 minute and 5 minutes in all infants with expanded recording at 5-minute intervals for infants who score seven or less at 5 minutes, and in those requiring resuscitation as a method for monitoring response. Scores of 7 to 10 are considered reassuring.

Apgar scores may vary with gestational age, birth weight, maternal medications, drug use or anesthesia, and congenital anomalies. Several components of the score are also subjective and prone to inter-rater variability. Thus, the Apgar score is limited in that it provides somewhat subjective information about an infant’s physiology at a point in time. It is useful in gauging the response to resuscitation but should not be used to extrapolate outcomes, particularly at 1 minute as this does not hold any long-term clinical significance. Apgar score alone should not be interpreted as evidence of asphyxia and its significance in outcome studies while widely reported is often inappropriate. Resuscitation should always take precedence over calculating a clinical score.

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