Apgar score

The Apgar score is named in honor of one of the pioneers of newborn (neonatal) care, Dr. Virginia Apgar. An anesthesiologist, she developed this scoring system to identify babies at risk for complications or bad outcome from delivery (specifically, cerebral palsy). It was designed to be simple, repeatable (that is, different observers arrive at about the same score), and predictive.

The baby is scored by delivery room or nursery personnel - nurses or doctors - typically at one and five minutes of age.

Apgar Scoring System
0 1 2

Appearance Pale Blue Pink

Pulse Absent <100 >100

Grimace Absent Grimace Cry Active

Activity Limp Some tone Active

Respiration Absent Irregular Reg & Cry

Zero, one, or two points are awarded for each category. The total of the individual category scores is the Apgar score for that scoring session. Thus a baby who at one minute was somewhat blue, with heart rate 120, an active cry, actively squirming, with regular respirations would receive an Apgar score of 1+2+2+2+2 = 9. That is about as good as they come at one minute; only an occasional baby gets a 10.

Much ado is made about Apgar scores, and most of it is meaningless. It turns out that one and five minute Apgar scores are not actually predictive of problems. If the Apgar score at twenty minutes after delivery is less than five, there is still only a 20% chance of a handicapping condition. These babies are obviously very sick and there is little gained from the Apgar score at that time that is not already pretty evident. But parents, wanting to get their children in the great race of life right out of the chute and eager to hear "how we are doing," want to have a number to chat about, so we give them one.

If a person writes APGAR and tries to explain that the letters stand for elements of the scoring system, that person is in error and does a disservice to the memory of Dr. Apgar, who remains among pediatricians an honored pioneer in the struggle to improve the outcome for newborns.

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