Understanding the APGAR

The Apgar score can be confusing, here are some tips to straightening it out!

Who would dare tell a new mom her newborn baby is anything but perfect? Individuals gazing through nursery glass windows are never anything but complimentary. This is understandable since, persons in their right minds, do not wish to incur the wrath of a loving mom. Visitors do not rate babies on a scale of one to ten according to their appearance.

However, before the delivery nurse deposits the little individual into the nursery, the wee one is given an intense ‘once over’ and a score is applied to his/her chart. The resulting grade is an APGAR score. Moms should not take offense to the on-site examination of their newborn, nor should they be insulted by the resulting score which varies anywhere between zero and ten.

The APGAR is the first of many tests your child will receive in her lifetime. It is also one of the most important. It is administered in order to access the immediate health of the newborn. The test was named for Dr.Virginia Apgar who developed it in 1952. In the years following, APGAR became a corresponding acronym to what the health provider observes about the newborn; A-appearance, P-pulse, G-grimace, A-activity, R-respiration.

The delivery room nurse observes the baby within the first five minutes after birth and applies a grade of sorts. The resulting number is either one or two. One is low and undesired while two is normal. The nurse applies a number to each category. The numbers are added together for a final score. Monitoring of the baby continues after the first scoring. After five minutes the baby’s appearance is analyzed once again and she is given a second score. The numbers from the second time around are added together, as were the first. A baby can test ten out of ten, though this is highly unlikely.

If your baby received a low number for the first score, immediate attention by the medical personnel is warranted. Possibilities for a low score after the first minute of birth include but are not limited to; lack of oxygen, or the nasopharynx (throat and nasal passages) require suctioning. A baby who does not improve significantly by the second score (at five minutes following birth) may be placed in the Neo Natal Intensive Care Unit.

For clarification, an APGAR score will appear something like this; 9/10. Nine represents the number applied to the baby’s condition after the first one minute and 10 is the number applied after the first five minutes. Most babies are born with slightly blue feet or hands. This is not unusual. By the time the second number is applied the feet will pink up.
Don’t panic if your baby receives an apgar score lower than 10/10. A delivery room nurse was heard saying, ‘only surgeon’s babies receive 10/10.’

The APGAR scoring criteria, according to the McGraw-Hill Dictionary of Modern Medicine, is:

Apgar score

Appearance
Color-0 for blue, 2 for pink
Pulse
Heart rate–0 for none, 1 for <100/min, 2 for > 100/min
Grimace
Reflex–0 for none, 1 for grimace, 2 for cough/sneeze
Activity
Muscle tone–0 for limp, 2 for full flexion

Respiratory effort
0 for absent, 2 for strong crying

Do not fear the APGAR score. It is simply a tool to ensure your baby is healthy in the
immediately after birth and to get him the added attention in the unfortunate event that he is not.