The Apgar test is done by a doctor, midwife, or nurse. The provider examines the baby’s:
- Breathing effort
- Heart rate
- Muscle tone
- Skin color
Each category is scored with 0, 1, or 2, depending on the observed condition.
- If the infant is not breathing, the respiratory score is 0.
- If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
- If the infant cries well, the respiratory score is 2.
Heart rate is evaluated by stethoscope. This is the most important assessment:
- If there is no heartbeat, the infant scores 0 for heart rate.
- If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
- If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.
- If muscles are loose and floppy, the infant scores 0 for muscle tone.
- If there is some muscle tone, the infant scores 1.
- If there is active motion, the infant scores 2 for muscle tone.
Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:
- If there is no reaction, the infant scores 0 for reflex irritability.
- If there is grimacing, the infant scores 1 for reflex irritability.
- If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.
- If the skin color is pale blue, the infant scores 0 for color.
- If the body is pink and the extremities are blue, the infant scores 1 for color.
- If the entire body is pink, the infant scores 2 for color.
Why the Test is Performed
This test is done to determine whether a newborn needs help breathing or is having heart trouble.
The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.
What Abnormal Results Mean
Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother’s womb.
Most of the time a low Apgar score is caused by:
- Difficult birth
- Fluid in the baby’s airway
A baby with a low Apgar score may need:
- Oxygen and clearing out the airway to help with breathing
- Physical stimulation to get the heart beating at a healthy rate
Most of the time, a low score at 1 minute is near-normal by 5 minutes.
A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.
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