The Apgar score is a simple assessment of how a baby is doing at birth, which helps determine whether your newborn is ready to meet the world without additional medical assistance. Your practitioner will do this quick evaluation one minute and five minutes after your baby is born.

1. Mukesh sah, MD,JI
Virgen Milagrosa University Foundation

2. APGAR SCORE
Mukesh sah- VMUF

5. WHY WAS THE APGAR SCORE
DEVELOPED?
 The score is named for the preeminent American anesthesiologist Dr. Virginia Apgar
(1909-1974), who invented the scoring method in 1952.
 Having assisted at thousands of deliveries, Dr. Apgar wished to focus attention on the
baby.
 Babies were traditionally dispatched directly to the nursery, often without much formal
scrutiny after delivery.
 Apgar wanted the baby to be assessed in an organized meaningful manner by the
delivery- room personnel.
 Dr. Apgar was the first woman to be appointed a full professor at Columbia University's
College of Physicians and Surgeons.

6. HOW IS THE APGAR SCORE DONE?
The Apgar score is a number calculated by scoring the heart rate,
respiratory effort, muscle tone, skin color, and reflex irritability
(response to a catheter in the nostril).
Each of these objective signs can receive 0, 1, or 2 points.

7. WHEN IS THE APGAR SCORING DONE?
 The Apgar score is done routinely 60 seconds after the birth of t
he infant and then is repeated five minutes after birth.
 In the event of a difficult resuscitation, the Apgar score may be
done again at 10, 15, and 20 minutes.

8. 1. MUSCLE
Muscle Tone:
TON
E
a.
b.
c.
Limp, flaccid = 0
Some flexing or bending = 1
Active motion = 2
2
1
0
points for vigorous motion
point for small flexing
points for no movement
THE 5 SIGNS:
Activity
P
G
A
r

9. 2. HEARTRATE
Heart Rate:
a.Absent heartbeat = 0
b. Slow heartbeat (less than 100 beats/minute)
1
=
c.Adequate heartbeat (more than
beats/minute) = 2
100
2
1
0
=
=
=
good strong heartbeat
slow but steady heartbeat
little or no heartbeat
A
P
G
A
r

10. 3.REFLEXE
SResponse to
Stimulation
Reflex Irritability):
(also calle
d
a.
b.
c.
No response = 0
Grimace (facial expression)
Vigorous cry or withdrawal
= 1
= 2
2
1
0
points if the baby cries
point if the baby grimaces (facial expression)
points for no movement or sound
A
P
Grimace
A
r

11. 4. COLO
R
a. Pale or blue = 0
b. Normal color body,
(arms and/or legs)
but blue extremities
= 1
c. Normal color = 2 – completely pink
A
P
G
Appearance
r

12. 5. RESPIRATOR
Y
EFFOR
T
Respiration
:a.
b.
c.
Not breathing = 0
Weak cry, irregular
Strong cry = 2
breathing = 1
2
1
0
points for a strong
point for a slow or
cry
weak cry
points for no cry at all
A
P
G
A
r

13. WHAT DOES A HIGH OR LOW APGAR
SCORE MEAN?
 A perfect Apgar score of 10 means an infant is in the best possible condition.
 An infant with an Apgar score of 0-3 needs immediate resuscitation.
 It is important to note that diligent care of the newborn is an immediate
response to the current status of the infant.
 It is inappropriate to wait until Apgar scores are obtained to begin or
continue to address the needs of the neonate.
The Apgar score was not designed to predict neurologic outcome.
Indeed, the score is normal in most patients in whom cerebral palsy subsequently develops, and the
incidence of cerebral palsy is low in infants with Apgar scores of 0-3 at 5 min (but higher than in infants
with Apgar scores of 7-10).

14. • Low Apgar scores and umbilical artery blood pH predict neonatal death.
• An Apgar score of 0-3 at 5 min is uncommon but is a better predictor of
neonatal death (in both term and preterm infants) than an umbilical
artery pH ≤7.0;
• The presence of both variables increases the relative risk of neonatal
mortality in term and preterm infants.
• Infants who fail to initiate respiration should receive prompt
resuscitation and close observation

15. WHAT DOES A PERSISTENTLY LOW
APGAR SCORE MEAN?
 The persistence of low (0-3) Apgar scores
at 20 minutes of age is predictive of high
rates of morbidity (disease) and mortality
(death).
 A low score may be the result of fetal
distress but may also be caused by a
number of factors, including prematurity
and drugs given to the mother during
labor

16. LIMITATION
S
Quick assessment
Does not necessarily
indicate a baby’s
long-term behavior

17. THANK YOU