What is the Apgar test ?

The Apgar test is a clinical examination of neonatology, used in the pediatric reception, where the pediatric clinician or certified neonatologist performs a test measured in 5 standards on the newborn to obtain a simple first assessment (macroscopic) and clinical status overall view of the newborn after delivery. This test is named after Virginia Apgar, an anesthesiologist specializing in obstetrics, who devised the test in 1952 at Columbia University’s Babies Hospital.

The newborn is evaluated according to five simple physiognomical parameters: skin color, heart rate, reflexes, muscle tone, and respiration. Each parameter is assigned a score between 0 and 2; adding the five scores gives the test result.

The test is performed at the minute, at five minutes, and, sometimes, at ten minutes after birth. The score at 1 minute assesses the newborn’s tolerance level to the birth process and its possible suffering, while the score obtained at 5 minutes assesses the newborn’s level of adaptability to the environment and its ability to recover. A newborn with a low score of one minute who obtains average results at five does not imply abnormality in its evolution. Otherwise, a newborn that scores 0 Apgar points should be clinically evaluated for her anatomical condition to determine a state of death.

The word APGAR can be used as an acronym or mnemonic rule remembering the evaluated criteria: Appearance, Pulse, Gesticulation, Activity, and Respiration.

What is the Apgar score?

The Apgar score is a test to evaluate newborns shortly after birth. This test assesses the baby’s heart rate, muscle tone, and other signs to determine if they need additional emergency medical help.

The Apgar test (also known as the “Apgar test”) is usually given to the baby twice: the first time, one minute after birth, and again, five minutes after birth. Sometimes, if the baby’s physical condition is of concern, the baby can be evaluated a third time.

What does “Apgar” mean?

The word Apgar refers to “Appearance, Pulse, Irritability (Grimace), Activity and Breathing.”

In the test, these five factors are used to assess the health of the baby. And each factor or aspect is evaluated on a scale that goes from 0 to 2, with 2 being the highest possible score:

Appearance (skin color)
Pulse (heart rate)
Irritability (reflex response) (from Grimace)
Activity (muscle tone)
Respiration (respiratory rate and respiratory effort)

The doctors, midwives/midwives, and nurses add these five factors to calculate the Apgar score. A baby can score between 0 and 10. 10 is the highest possible score, but very few babies reach it. This is because many babies’ hands and feet remain blue until they warm up.
The Apgar test is a quick test done the first and fifth minutes after the baby is born. The score at minute 1 determines how well the baby tolerated the birthing process. The score at minute 5 tells the healthcare provider how well the baby is doing outside the womb.

In rare cases, the exam will be finished 10 minutes after birth.

Virginia Apgar, MD (1909-1974), began using the Apgar score in 1952.
How the test is performed

The Apgar test is performed by a doctor, midwife, or nurse. The provider tests the baby for:

Respiratory effort
Heart rate
Muscular tone
Reflexes
Skin color

Each of these categories is given a 0, 1, or 2 depending on the observed state.

Respiratory effort:

If the baby is not breathing, the score is 0.
If the breaths are slow or irregular, the baby scores 1 for respiratory effort.
If the baby cries well, the respiratory score is 2.

The heart rate is evaluated with the stethoscope. This is the most crucial evaluation.

If there is no heartbeat, the baby's score is 0 for heart rate.
If the heart rate is less than 100 beats per minute, the baby scores 1 for heart rate.
If the heart rate is more significant than 100 beats per minute, the baby scores 2 for heart rate.

Muscular tone:

If the muscles are loose and floppy, the baby scores 0 for muscle tone.
If there is some muscle tone, the baby's score is 1.
If there is active movement, the baby scores 2 for muscle tone.

Response to gesticulations (grimaces) or irritability reflex is a term that describes the response to stimulation, such as a slight pinprick:

If there is no reaction, the baby's score is 0 reflecting irritability.
If there are gestures or grimaces, the baby's score is 1 in a reflex of irritability.
If there are gestures and a vigorous cough, sneeze, or cry, the baby's score is 2 reflecting irritability.

Skin color:

If the skin color is pale blue, the baby's score is 0 for color.
If the baby's body is pink and the limbs are blue, the score is 1 for color.
If the baby's entire body is pink, the score is 2 for color.

What does my baby’s Apgar score mean?

A baby who scores seven or higher on the Apgar Test is generally considered in good health. Getting a lower score does not mean that the baby is sick. All it means is that the baby needs some immediate medical treatment, such as suctioning his airways or giving him oxygen, to help him breathe. Some perfectly healthy babies have lower scores than usual, especially in the first minutes of life.

A somewhat lower score (especially at minute 1) is standard, especially in babies born:

high-risk pregnancies
by cesarean section
after a complicated delivery
prematurely

Five minutes after birth, the Apgar test is applied again. Suppose the baby’s score was low on the first evaluation and did not improve, or the medical staff is concerned about the baby’s condition for other reasons. In that case, the medical and nursing staff will continue to apply to l baby the necessary medical treatment. And they will closely monitor the baby.
What if my baby has a low Apgar score?

Many babies with low Apgar scores are perfectly healthy and do well after adjusting to life outside the womb.

If your child’s doctor and midwife (or midwife) are concerned about your baby’s Apgar score, they will let you know and explain what, if any, may be causing problems and what treatment you are receiving.
What else do I need to know?

This test was not developed to predict babies’ long-term health, behavior, intellectual level, personality, or performance. The test is designed to help healthcare professionals assess the physical condition to know whether or not she needs immediate medical care quickly.

With the time needed to adjust to the new extrauterine environment and necessary medical care, most babies respond very well. So instead of focusing so much on one number, dedicate yourself to enjoying the arrival of your newborn!