What does your baby’s Apgar score mean?

checking newborn's Apgar score
Don’t get too wrapped up in your baby’s Apgar score; it almost never reflects a baby’s future health.

Babies take their first test one minute after birth. Apgar scores have been assigned to newborns for more than half a century, although they are often misunderstood by parents.

The test was developed by anesthesiologist Virginia Apgar, who wanted a way to compare the effects of different practices on newborn babies. For example, if there were two different pain medications that a mother could receive, she wanted to be able to measure and compare the effects on the newborns immediately after birth.

How the test is administered and scored remains unchanged since 1952, although today we typically see it as a tool to assess how a baby is transitioning from fetal life to newborn life.

I find that parents tend to obsess over their baby’s Apgar score. In this day and age where competition starts early in life, a low score looks like their baby didn’t perform well. Parents can recall their children’s Apgar scores like they do their own SAT scores – I know I do. But we also need to remember that the Apgar score is not generally a predictor of future health, it’s just a quick glimpse at a newborn’s condition at a specific point in time.

What does the Apgar test measure?

The Apgar test scores five elements on a scale of 0 to 2 for a total score that can range from 0 to 10:

 

0

1

2

Color

Bluish-gray or pale all over

Bluish hands and/or feet

Pink

Heart rate

No pulse

Below 100 beats per minute

Above 100 beats per minute

Reflex

No response

Facial movement only

Pulls away, sneezes, coughs, or cries with stimulation

Muscle tone

No movement

Arms and legs flex with little movement

Active, spontaneous movement

Respiration

No breathing

Slow or irregular breathing, weak cry

Normal rate and effort, good cry

The test is given to a baby both at one minute and five minutes after birth. If the Apgar score is below 7 at five minutes, we’ll do it again at 10 minutes.

This doesn’t mean that if your baby needs help breathing, we sit around and wait until the one-minute test tells us so. We’ll start resuscitation efforts immediately if it’s needed. The Apgar score is just a quick way for us to assess a newborn’s condition at one minute of life.

If your baby doesn’t get a 10 at one minute or even after five minutes, don’t worry. Very few babies get a perfect Apgar score in fact at our hospital, fewer than 1 in 100 get that perfect 10. Most newborns lose at least a point for color; it’s normal for a baby’s hands and feet to be a little blue – it’s just part of the process a baby’s circulation goes through adapting to life outside the uterus. If your baby’s score is 7 or more, you should be reassured that your baby is transitioning well.

What does an Apgar score mean for a baby’s future?

If your baby gets low Apgar scores at one and five minutes, very rarely does it mean your baby will have a difficult newborn course or face a life of health problems. There are a lot of things than can impact a baby’s score.

For example, my second daughter had scores of 2 and 7 at one minute and five minutes of life. Two may sound scary and way too low to be normal, but she was the second of a twin delivery, she was breech, and she was premature. All these things can impact the scores. Sedation also can affect an Apgar score. If mom has received pain medication recently, the baby may be a little sleepy from the drug and have less respiratory effort.

If the Apgar score is below 7 at five or 10 minutes, we may need additional information from the delivery – don’t panic, it doesn’t mean that something bad happened during your delivery. Was the baby undergoing a procedure at the time the score was taken? What does the blood test from the umbilical artery tell us? Does an examination of the placenta help explain the infant’s condition? Taking a look at the bigger picture can often give us more clues to how the infant is transitioning to newborn life and what might have made the transition a little more rocky than normal.

Putting the Apgar score into perspective

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) released a joint policy statement in September in an effort to remind healthcare providers and the public to keep Apgar scores in perspective.

“The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose.” That’s a strong statement that I think should be reassuring to parents.

Also in the statement, the groups encourage healthcare professionals to take additional information into account when interpreting the Apgar score. In the event the infant needs additional attention In the delivery room, they even suggest a modified record that provides more details on exactly what was happening with the infant in the first few minutes of life – things like medications given and whether the infant was requiring additional oxygen. The goal is to have the most accurate picture of what the infant’s condition is early in life.

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