Apgar Score Page

The Apgar score is an objective scoring system based on five clinical signs:

1. Heart rate
2. Respiratory effort
3. Reflex irritability
4. Muscle tone
5. Color

A score from zero to two is possible in each category, and a perfect score is ten. Even normal newborns rarely score a perfect score due to some degree of acrocyanosis. Apgars are usually done at 1 and 5 minutes after delivery. The Apgar is indicative of the degree of neonatal compromise and is a tool to gauge intervention required to stabilize newborns.

• Apgar score 8 to 10: These infants require no specific treatment. Monitoring must be performed for at least 5 additional minutes to be certain that hypoventilation does not occur, and routine care should be taken to prevent hypothermia.
• Apgar score 5 to 7: These infants have had minor asphyxia during birth and require stimulation and an oxygen-enriched environment. Stimulation can be accomplished by vigorously rubbing the baby's back or by gently flicking the soles of the feet. Oxygen can be supplied from a Mapleson-type resuscitation bag. Self-inflating bags deliver oxygen only during positive pressure ventilation and thus are ineffective for this purpose.
• Apgar score 3 to 4: Bag and mask ventilation should be started if stimulation does not establish adequate respiration or if the heart rate decreases to less than 60 to 80 beats per minute and cardiac compressions should be immediately initiated.
• Apgar score 0 to 2: These infants require immediate initiation of CPR.