new born infant in the operation roomIntroduction

Assessing your baby’s health and well-being begins from the moment they are born – this very first assessment is called the Apgar score. It is undertaken by the midwife or paediatrician (baby doctor) present at your baby’s birth and is designed to evaluate their physical health and well-being immediately at birth.

Background information

The Apgar score was invented by an obstetric anaesthetist named Virginia Apgar. It was not intended to predict mortality (ie those babies who might die), but she did hope to reveal a relationship between the baby’s condition at birth and their longer term neurological (brain) development and health outcomes. Because the score is usually recorded retrospectively and subjectively there can be variation in practitioners’ scoring. Consequently, some health professionals believe that use of the Apgar score may be unreliable. Many hospitals have never recorded the Apgar score and some no longer do so. Although it has been assumed that there is a close relationship between the Apgar score and whether the baby has been starved of oxygen at birth, research has shown that this is not necessarily the case.

How does it work?

Your baby’s condition is assessed at one minute, five minutes and, if there are any concerns, at 10 minutes after their birth. The Apgar score helps identify those babies requiring immediate assistance with their breathing and/or extra care; however, it cannot predict a baby’s longer-term health and well-being.

The term ‘Apgar’ is commonly referred to as an acronym for:

A – Activity (baby’s movements, muscle tone)

P – Pulse (heart rate)

G – Grimace (reflex response)

A – Appearance (skin colour – a good colour, or pale?)

R – Respirations (breathing)

A score between 0-2 is given for each of these factors and then added together at each time interval (1, 5 and 10 minutes) to calculate your baby’s Apgar score — scores obtainable range from the maximum of 10 to 0. If your midwife/paediatrician is concerned about your baby’s Apgar score, they will explain why and let you know what care is being given, and how your baby is responding to that care.

References and further reading

Bharti B, Bharti S (2005). A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings. Journal of Clinical Epidemiology 58(2):121-129.

Newborn Life Support – Resuscitation at Birth (3rd edition) (2011). London: Resuscitation Council (UK).

O’Donnell CP, Kamlin CO, Davis PG et al (2006). Interobserver variability of the 5-minute Apgar score. Journal of Pediatrics 149(4):486-489.

Sykes G, Molloy P et al (1982). Do apgar scores indicate asphyxia? Lancet: 494-496.