The APGAR score is a method to quickly evaluate the health of newborn babies. It was created in 1952 by Dr. Virginia Apgar and assesses babies on five criteria: appearance, pulse, grimace, activity, and respiration. Scores are given from 0-2 on each criteria with higher scores indicating better health. APGAR scores are determined at one and five minutes after birth to evaluate how well babies are adapting outside the womb. While it is a useful guide, the APGAR score alone does not predict long-term health issues and should not be used to diagnose asphyxia without other evidence.

1. APGAR Score
 Shakuntala Chauhan
 Payal Maurya
 Mahesh Chand Meena
 Pushpam Saroj
 Shweta Kumari
Group
Members

2. APGAR Score
Introduction
 It Is Named After The American Physician And Anesthesiologist Virginia Apgar .
 She Developed It As A Rapid Means Of Evaluating The Clinical Status Of The
Newborn In 1952 .
 APGAR Score Is Based On 5 Elements , Which Are Named After The Letters In Apgar's
Name :-
A
P
G
A
R
Appearance {Skin Color}
Pulse {Heart Rate}
Grimace {Responses & Reflexes}
Activity {Muscle Tone}
Respiration
 An Objective Score Of The Condition Of A Baby After Birth.

3. Virginia Apgar
 Born :- June 7, 1909 West Field , New Jersy , U.S
 Died :- August 7, 1974 Manhattan New York , U.S
 Occupation :- Anesthesiologist
 The Medical Specialty Concerned With The
Total Perioperative Care Of Patients Before,
During And After surgery.
 Profession :- Doctor
 Notable Work :- Is My Baby All Right ? A Guide To Birth Defects [With Joan Beck] {1972}

4. The APGAR score Helps Medical Staff Decide If the Baby Needs Medical Or Emergency Care .
 The Checks Are Conducted At One Minute and Five Minutes After Birth .
 The First Minute Score Is Used To Ascertain How The Neonate Tolerated The Birthing Process
 The Five Minute Score Can Show The Condition Of The Neonate Outside Mother's Womb .
 The Checks May Be Continued Every Five Minutes For Up-to Twenty Minutes In Neonates Who Received A Low Score At
Five Minutes .
APGAR Checks
Scores
 The APGAR Score Checks Five Characteristics Of The Baby -
 Skin Color
 Heart Rate
 Reflexes And Responsiveness
 Muscle Tone
 Breathing Rate
 Each Characteristic Is Rated From Zero [0] To Two [2] With Two Being The Best Score .
 The Sum Of The Scores Of The Five Components Is The Total Score [5*2 = 10]

5.  The Higher The Score , The Better The Baby Is Doing After Birth .
 A Score Of 10 Is Very Unusual , Since Every Newborn Loses One Point For Blue Hands And Feet , Which is Normal
After Birth
 A Score Of 7 , 8 , And 9 is Considered Normal , And Is A Sign That The Newborn Is In Good Health . This Score Is
Considered Good to Excellent .
 A Score Of 6 Or Less At One Minute And 7 Or More At 5 Minutes Is Also Considered Normal .
 A Score Below 7 In The Second Test At Five Minutes Is Considered Low .
 A Score of 4 Or Less At The Five Minutes Test Is considered Critical .
Normal
[Good – Excellent]
Low
Critical
A Score Of - 7 Or More
A Score of 6 & 5
A Score of 4 Or Less
Interpretation

6.  A Low APGAR Score Gives Doctors A Warning That They Should Check The Baby For Hidden Health Problems , Such As
Breathing Difficulties Or Internal Bleeding And Allows Them To Give The Baby Crucial Medical Attention When It Is
Most Needed .
Technique
 The following Technique Is Used In Apgar Score System To Compute The Score :-
Appearance  Pinkness & Blueness Of Baby's Skin-Tone
 Because Peripheral Cyanosis Is Frequent Among Normal Babies , Most Infants Will Receive A
Score Of One For Color. In Non-white Infants, Color Can Often Be Deceiving
0
1
2
Color
Score
 If The Baby's Skin Color Is Pale Or Blue
 If The Infant Is Pink But The Extremities Are
Blue [Pink Body , Blue Fingers And Toes]
 The Infant Is Totally Pink

7. Pulse
[Heart Rate]
 Most Important Aspect Of The Score In Assessing The Necessity For Resuscitation .
 Heart Rate Is Expressed As Beats Per Minutes [bpm]
 Heart Rate Is Usually Measured By Finding The Pulse In The Body , At Each Beat The Heart Pumps
Blood Into The Blood Vessels. As The Blood Flows Into The Blood Vessels The Blood Vessels
Expand And This Is Felt As A Pulse.
Heart Rate
Score
0
1
2
No Heartbeat
Heart Rate Is Fewer than 100 bpm
Heart Rate Is Greater Than 100 bpm

8. Grimace
Responses & Reflexes
 Grimace Response or Reflex Irritability in Response to Stimulation .
 The Medical Team Will Assess If The baby Has No Response To Stimulation, Replies With
A Grimace, Or Responds By Crying And Pulling Away During This Exam .
Grimace
Score
0
1
2
 No response When the Sole Of the foot Is Stimulated
 Baby Grimaces When The sole Of the foot is Stimulated
 Facial Movement
 Baby Cries When The Foot Is Stimulated
 Sneezes & Cough & Cries

9. Activity
[Muscle Tone]
 The Resistance Of A Muscle To Active Or Passive Stretch , Or The Overall Stiffness Of The
Muscle.
 The Medical Team Will Assess If The Infant Is Limp, If The Infant Has Some Flexion [Joint
Movement] , Or If The Infant Has Active Motion During This Examination .
Activity
Score
0
1
2
 Baby is limp
 Baby Shows Some Muscle Flexing In It 's Feet And Hands
 Baby Is Active And Can Flex The Muscle In it' s Feet And Hands

10. Respiration  Rate of Baby's Breathing
 During This Procedure, The Medical Team Determines Whether The Infant Is Having Trouble
Breathing, Has A Faint Cry And Delayed Breathing, Or Is Breathing Regularly And Crying
Normally.
Respiration
Score
0
1
2
 Infant Is Not Breathing
 Breathing Is Slow , Irregular ,
Weak Or Gasping .
 Baby Has a Weak Cry
 Baby Is Crying A lot [Strongly]
 Baby Is Breathing Well

11.  APGAR
Score
CHART

12. Reasons For Low APGAR Score
 C-Section Errors And Delays - Surgical Procedure Performed
When A Vaginal Delivery Is Not Possible Or Safe, Or When
The Health Of The Mother Or The Baby Is At Risk .
 Fetal Monitoring Errors.
 Infections.
 Maternal Medical Conditions.
 Placental Abruption - Premature Separation Of The Placenta
From The Uterus
 Preterm Birth - Childbirth That Occurs Before 37 Weeks Of
Pregnancy.
 Prolonged And Arrested Labor - When Labor Lasts For
Approximately 20 Hours Or More For A first-time Mother,
And 14 Hours Or More if You Have Previously Given Birth.
 Umbilical Cord Problems.
 Fluid In the Baby's Airway [Amniotic Fluid]

13. Limitations Of APGAR Score
v The APGAR Score Is Just Only A Guide . It Does Not Mean
That There Going To Be Any Problems Later In Life
v It Does Not Predict The Baby's Long Term Development
v The Apgar Score Is A Subjective Assessment Of The Infant's
Physiologic Status . A Healthy Children May Obtain A Low
Score
 Individual Neonatal Mortality Or Neurologic Outcomes Are Not
Predicted By The Apgar Score .

14. Recommendations
 Individual Neonatal Mortality Or Neurologic Outcomes Are Not Predicted By The Apgar Score , And It
Should Not Be Utilized For That Purpose
 The Apgar Score Should Not Be Used Alone To Determine The Presence Of Asphyxia. Unless Specific
Evidence Of Severely Decreased Intrapartum Or Immediate Postnatal Gas Exchange Can Be Recorded
 The Word Asphyxia, Which Denotes A Process Of Varying Severity And Length Rather Than An Endpoint,
Should Not Be Applied To Birth Events.
 Umbilical Artery Blood Gas From A Clamped Piece Of The Umbilical Cord Should Be Taken When A Newborn Has
An Apgar Score Of 5 Or Less At 5 Minutes. It may Be Beneficial To Have The Placenta Pathologically Examined.
 During Resuscitation, Perinatal Health Care Providers Should Assign An Apgar Score Consistently.

15. References
• Apgar Score: Chart, Definition, Normal, Baby,
and More (healthline.com)
• Apgar score: MedlinePlus Medical
Encyclopedia
• APGAR Score - StatPearls - NCBI Bookshelf
(nih.gov)
• Apgar Score - Interpretation, Limitations and
Clinical Significance (vedantu.com)