APGAR SCORING
Masumbuko Baluwa
OBJECTIVES
• Overview of Apgar scoring
• Explain the significance and components of Apgar scoring
APGAR SCORING
• The Apgar score was devised by Dr. Virginia Apgar in
1953 and is a commonly quantitative measure of
neonates wellbeing at and around birth.
• The purpose of the Apgar score is to evaluate
physical condition of the newborn at birth and the
immediate need for resuscitation.
• The newborn is rated at 1minute and 5 minutes
after birth and it gives a total score ranging from 0
to 10.
• The 1 minute score indicates the degree of central
suppression of the baby and is important for further
management of resuscitation.
• The 5 minute score indicates the baby’s ability to adapt
to extrauterine life and is also a reliable predictor of
the risk of death during the first 28 days of life and the
child neurological state and risk of major disability at
the age of 1 year.
• The higher the Apgar score the better the outcome of
the baby.
• The mnemonic for Apgar score is:
• A Appearance (i.e. color)
• P Pulse (i.e. heart rate)
• G Grimace (i.e. response to stimuli)
• A Active (i.e. tone)
• R Respirations
The five indicators used are;
Heart rate:
Auscultate or palpate at the junction of the umbilical
cord and skin.
This is the most important assessment.
A newborns heart rate of less than 100 beats per
minute indicates need for immediate resuscitation
Absent=0, Slow irregular <100=1, Fast>100=2
Respiratory effort:
Second most important assessment.
Complete absence is termed apnea and a vigorous cry
indicates good respirations.\
Absent= 0, Slow irregular= 1, Good crying = 2
The muscle tone:
Evaluate the degree of flexion and resistance
to straightening of the extremities.
 A normal term newborns elbow’s and hips
are flexed, with the knees positioned up
towards the abdomen.
Limp=0 some flexion of extremities=1, active
motion= 2
Reflex irritability:
Evaluate as the newborn is dried or by lightly
rubbing the soles of the feet.
A cry is a score of a 2 and a grimace is a 1 and
no response is 0.
Skin color
inspect cyanosis and pallor.
 Newborns generally have blue extremities
and the body is pink which merits a score of
1. This condition is termed acrocyanosis and
is present in 85% of normal newborns at a 1
minute after birth.
A completely pink newborn scores 2 and a
totally cyanotic, pale newborn score 0.
Newborns with darker skin pigmentation
will not be pink. Their skin color is assessed
for pallor and acrocyanosis and a score is
selected based on assessment.
0
Absent
1
Slow <100
2
Fast >100
Respirator Absent
y Rate
Muscle
Limp
Tone
Slow,
irregular
Some
flexion of
extremities
Grimace
Good,
crying
Active
motion
Heart rate
Reflex
Irritability
No
response
Color
Pale blue
Body pink,
extremities
blue
Vigorous
cry, cough
or sneeze
Completely
pink
• A score of 8 to 10 indicates that the neonate is in good
condition
• A score of 4 to 7 indicates the need for stimulation
and a score under 4 indicate the need for
resuscitation.
• The midwife should normally expect a score of about
9 in a normal term newborn due to acrocyanosis
caused by poor peripheral circulation. However some
Newborn can give a score of 10