APGAR Score 

Overview:

The APGAR score is a quick assessment tool used to evaluate the physical condition of a newborn immediately after birth. The score is named after Dr. Virginia Apgar, an American anesthetist who developed it in 1952.  APGAR scoring can also help us understand what the babies condition was like in utero. Poor APGAR scoring can potentially mean the baby was compromised or stressed before birth.

The APGAR score  is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7.  

1. Timing:

The APGAR timer starts when baby is completely removed from the mother! Not just the head or a limb. 

a. 1 minute – to evaluate the baby’s immediate adaptation to life outside the womb. 

b. 5 minutes – to assess if the baby’s condition has improved after initial resuscitation efforts, if necessary. 

c. Every 5 minutes after – if needed, particularly if the 5-minute score is less than 7, and the baby requires additional support or monitoring.  

 A score of 10 is rarely given because at 1 minute of life, peripheral cyanosis is common. 

2. APGAR Scoring: 

A - Appearance (Skin Color): 

• 0 points: Blue or pale all over 

• 1 point: Body pink, but extremities are blue 

• 2 points: Pink all over 

Significance: Appearance reflects the baby's overall oxygenation and perfusion. 

P - Pulse (Heart Rate): 

• 0 points: Absent 

• 1 point: Below 100 beats per minute 

• 2 points: Above 100 beats per minute 

Significance: Heart rate assesses the cardiovascular system's ability to adapt to the newborn's new environment. 

G - Grimace Response (Reflexes/Irritability): 

• 0 points: No response to stimulation 

• 1 point: Grimace or weak cry when stimulated 

• 2 points: Vigorous cry or pulls away when stimulated 

Significance: Grimace response evaluates the baby's reflexes and neurological function. 

A - Activity (Muscle Tone): 

• 0 points: Limp or floppy 

• 1 point: Some flexion of limbs 

• 2 points: Active motion, well-flexed limbs 

Significance: Muscle tone reflects the baby's neuromuscular maturity and overall strength. 

R - Respiratory Effort: 

• 0 points: Absent 

• 1 point: Weak, irregular, or gasping 

• 2 points: Strong cry 

Significance: Respiratory effort assesses the baby's ability to breathe independently. 

3. Interpretation of Scores: 

• 7-10 points: Generally considered normal. 

• 4-6 points: Moderate difficulties, may require some medical attention. 

• 0-3 points: Severe distress, requires immediate medical intervention. 

4. Key  Points: 

• Quick Assessment: The APGAR score is a rapid and initial assessment of a newborn's well-being. 

• Repeat Scoring: It is common to reassess the APGAR score at different time intervals to monitor the baby's progress. 

• Medical Intervention: Low APGAR scores may prompt immediate medical attention to address any emerging issues. 

5. Why is the APGAR Score Important to the NICU RT? 

• Immediate Assessment: This immediate assessment allows NICU RTs to quickly evaluate the newborn's condition and response to the birthing process.

• In-Utero Assessment: APGAR scoring can also help us understand what the babies condition was like in utero. Poor APGAR scoring can potentially mean the baby was compromised or stressed before birth. 

• Quick Decision-Making: Apgar scores help NICU RTs and other healthcare providers make rapid decisions about the need for immediate interventions. If the scores are low, it may trigger a more in-depth assessment and prompt action to stabilize the newborn. 

• Communication: Apgar scores provide a standardized way for healthcare professionals, including NICU RTs, to communicate with each other about the newborn's status. This facilitates effective teamwork and coordinated care.