Apgar Score

The Apgar score was devised in 1952 by Dr. Virginia Apgar (1909–1974) as a quick and simple method of assessing the condition of newborn infants. Typically an infant is assessed at 1 and 5 min after birth in five areas of functioning, each of which is assigned a score from 0 to 2. The five scores are summed, and a higher score indicates better health; a score of 7 or higher (out of a possible 10) indicates good to excellent health. The five areas of functioning, with their mnemonic in parentheses, are skin color (appearance), heart rate (pulse), reflex irritability (grimace), muscle tone (activity), and respiration (respiration). These areas were selected from a larger list of objective signs of infant health because delivery room personnel could be easily taught to evaluate them using the 0 to 2 scale.

The first use of the Apgar scale in research was a review in 1953 by Virginia Apgar of 1,025 infants born alive at Columbia Presbyterian Hospital in New York City. She found that Apgar score was related to the type of birth (higher scores were associated with vaginal births with the occiput presenting, and lower scores with breech extraction and version) and the use of anesthesia (which was associated with lower scores). Lower scores were also associated with higher neonatal death rates: Mature infants with scores of 0 to 2 had a 14% death rate, those scoring 3 to 7 a 1.1% death rate, and those scoring 8 to 10 a 0.13% death rate.

The Apgar score was quickly adopted for both infant assessment and research purposes, and the 5-min evaluation became common after a study of more than 54,000 births occurring during 1959 to 1966, in which the Apgar score at 5 min was found to be more predictive of neonatal mortality than the 1-min score. This was confirmed in an analysis of more than 150,000 infants born in Texas in the years 1988 to 1998, which found a strong correlation between the 5-min Apgar score and neonatal mortality. Preterm births with 5-min Apgar scores of 0 to 3 had 315 neonatal deaths per 1,000, those with scores of 4 to 6 had 72 neonatal deaths per 1,000, and those with scores of 7 to 10 had 5 deaths per 1,000. [Page 41]For full-term births (37 weeks of gestation or later), those with 5-min Apgar scores of 0 to 3 had 244 neonatal deaths per 1,000, those with scores of 4 to 6 had 9 deaths per 1,000, and those with scores of 7 to 10 had 0.2 deaths per 1,000.

The Apgar score has been criticized because it has been used for purposes for which it was never intended—for instance, to predict the neurologic development of the infant or to serve as an indicator of hypoxia. Apgar scores are also influenced by several extraneous factors, including the maturity of the infant (a healthy preterm baby may receive a low score because of its immaturity) and maternal use of certain medications. However, the usefulness of

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