What’s the Score?
Transitioning from life inside the womb to life outside of it is no small feat — it’s amazing that so many babies around the world do it every day.
Sometimes babies may need support in the first few minutes of life. It’s not uncommon for a baby to be sleepy or slightly stunned right after birth. The Apgar score helps medical staff determine the interventions that need to be taken to help a newborn who is having difficulty adjusting to this new environment.
Developed in 1952 by Dr. Virginia Apgar, the Apgar score’s letters can also stand for Appearance (color), Pulse (heart rate), Grimace (reflex), Activity (muscle tone) and Respiration. Each category is assigned a score of 0, 1 or 2, depending on a baby’s condition. Babies receive a score of 1 to 10 at one minute and again at five minutes of life, then at intervals of five minutes, if necessary.
What the Numbers Mean
A baby with a heart rate of 140 (2 points), crying weakly (1 point), moving vigorously (2 points), with a slight grimace (1 point) and a blue color to the skin (0 points) would be given an Apgar score of 6. If, after a few minutes, the cry becomes loud and the baby starts sneezing, but is still blue, the score would increase to 8.
Most newborns have Apgar scores of 8 or 9. A score of 10 is rare since newly born babies usually have persistent blue of the hands and feet, which takes a point off in the color category.
Scores of 7 and lower are usually due to conditions during the time of delivery — such as prematurity, a difficult birth process or a C-section. Depending on the score, your baby may need interventions ranging from simple stimulation to administering oxygen with or without the help of a few rescue breaths.
Most babies respond very rapidly to these measures and require them for only a brief time. Very rarely, newborns will need CPR or medications if they are not responding well.
Many parents worry that low Apgar scores mean that their baby will have health problems in the future, but the Apgar score does not predict this. In fact, most newborns with somewhat low initial scores are perfectly healthy, so don’t focus on the number — there will be more than enough report cards to comb through in the future!
Pediatrician Elizabeth Shashaty, MD, is on staff at Children’s National Medical Center and Medstar Georgetown University Hospital, both in Washington, DC. She is also the mother of three young children.