Apgar Score

APGAR SCORE

The APGAR SCORE is a quick test performed on the newborn at one and five minutes after birth.
The one minute score assesses how well the infant tolerated the birth. The five minute score assesses how well the infant is adapting to the new environment.
Five areas are assessed: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort). If the infant has a strong cry, the respiratory effort receives a top score of 2.
Each area receives a 0 to 2 score with a maximum total of 10 points.
The test identifies infants who need medical attention to stabilize heart or breathing function.
Most infants score between eight and ten.
If the delivery is difficult, the infant may receive less than adequate oxygenation. A lower initial apgar score may result.
Fewer than 2% of infants have an apgar score of less than seven at five minutes.

**Use this table to score the infant under QUIZ ME**
SCORE	0	1	2
Appearance (Skin color)	Blue or Pale	Body pink; hands and feet blue	Completely pink
Pulse (Heart Rate)	Absent	< 100 beats per minute	> 100 beats per minute
Grimace (Reflex Irritability)	Absent	Grimace	Grimace (or vigorous cry) and cough or sneeze
Activity (Muscle Tone)	Limp	Some flexing of arms and legs	Active flexing of arms and legs; active motion
Respiration	Absent	Slow, irregular respirations; weak cry	Good respirations (30-60): strong cry

To elicit a grimace, the infant is lightly pinched. If there is grimacing or a vigorous cry and a cough or sneeze, the infant scores a 2 for Grimace or reflex activity.
To receive a score of 10, the infant will be completely pink, have a heart rate > 100, grimace (make a face) and cough or sneeze, actively move and flex arms and legs and have a strong cry and good (30-60) respirations.
An newborn with all of the above but with blue feet or hands receives a 9 out of 10 Apgar score.

APgar ADAM.jpg

Healthy Response to Birth

If the infant is pink, the arms and legs are actively pulled toward the body, the baby is crying and does not have retractions or nasal flaring, the infant may be placed skin-to-skin on the mother's chest. If the mother in unable to hold the infant, it may be placed skin-to-skin on the father's chest. See side panel for benefits of early skin-to-skin contact.


Mother and infant, skin-to-skin	Dad and infant, skin-to-skin

At Risk Response to Birth

If the infant is not breathing or has not cried, neonatal resuscitation will be needed. This begins with stimulation of the infant and oxygen by mask. If the infant does not cry or breathe, an endotrachial tube may be inserted to provide oxygen to the lungs, chest percussions may be initiated and the infant will quickly be transported to the NICU (neonatal intensive care unit).
If the infant has signs of respiratory distress such as nasal flaring, retractions, grunting and rapid respirations, the infant will be monitored closely under the warmer and will not be placed skin-to-skin until these signs are gone.

Value: 1