Apgar score

A rating on a scale of 1 to 10 given a newborn baby, according to criteria published by the pediatrician Virginia Apgar in 1953.¹ A “10” represents the apparently healthiest baby.

Scoring is preferably done by someone other than the person who delivered the baby.² Two scores are recorded: the first at 60 seconds after birth (defined as the moment when the soles of the feet and the top of the head are visible), and the second at 5 minutes after birth. Both scores are based on the same five factors, on each of which the observer may award either 0, 1 or 2 points³:

Factor	0	1	2
color	blue pale	body pink extremities blue	completely pink
heart rate	absent	below 100	over 100
breathing	absent	slow, irregular	good strong cry
reflexes (response to stimulation of sole of foot)	no response	grimace	cry
muscle tone	limp	some flexion of extremities	active motion

An Apgar score is a way of alerting the nursery staff to newborns who may require special attention, but it is primarily a tool for studying the effects of treatments on groups of infants, not individuals. It has been used, for example, in comparing the quality of care in different obstetrical units. Anxious mothers should note first, that a rating of 10 is not often given, and second, Apgar's caution that the score does not “predict neonatal death or survival in individual infants.”⁴

1. Virginia Apgar.
A proposal for a new method of evaluation of the newborn infant.
Anaesthesia and Analgesia, volume 32, page 260, (1953).

2. Virginia Apgar.
The newborn (Apgar) scoring system. Reflections and advice.
Pediatric Clinics North America, vol. 13, no. 3, pages 645-650 (August 1966).

3. Table adapted from
J. Butterfield and M. J. Covey.
Practical epigram of the Apgar score. (letter to the editor)
JAMA, volume 181, page 353 (28 July 1962).

4. Virginia Apgar and L. S. James.
Further observations on the newborn scoring system.
American Journal of the Diseases of Children, volume 104, page 419 (1962).