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What is the Apgar score?

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.

This score – developed in 1952 by anesthesiologist Virginia Apgar and now used in modern hospitals worldwide – rates a baby's appearance, pulse, responsiveness, muscle activity, and breathing with a number from 0 to 2 (2 being the strongest rating). The five numbers are then totaled.

It's easy to remember what's being tested by thinking of the letters in the name "Apgar": Activity, Pulse, Grimace, Appearance, and Respiration. Here's how each is used to assess a baby's condition at birth:

Activity (muscle tone)
0 Limp; no movement
1 Some flexion of arms and legs
2 Active motion

Pulse (heart rate)
0 No heart rate
1 Fewer than 100 beats per minute
2 At least 100 beats per minute

Grimace (reflex response)
0 No response to airways being suctioned
1 Grimace during suctioning
2 Grimace and pull away, cough, or sneeze during suctioning

Appearance (color)
0 The baby's whole body is completely bluish-gray or pale
1 Good color in body with bluish hands or feet
2 Good color all over

Respiration (breathing)
0 Not breathing
1 Weak cry; may sound like whimpering, slow or irregular breathing
2 Good, strong cry; normal rate and effort of breathing
What do the Apgar scores mean?

The one-minute Apgar score
The first Apgar score helps your practitioner decide whether your baby needs immediate medical help. If your baby scores between 7 and 10, it usually means he's in good shape and doesn't need more than routine post-delivery care. (Don't be disappointed if your baby doesn't score a perfect 10. It's unusual for a baby's hands and feet to have good color one minute after arrival.)

If your baby scores between 4 and 6, he may need some help breathing. This could mean something as simple as suctioning his nostrils or massaging him, or it could mean giving him oxygen. If your baby scores 3 or less, he may need immediate lifesaving measures – a full-fledged resuscitation. Keep in mind that a low score at one minute doesn't mean that your baby won't be just fine eventually. Babies born prematurely or delivered by cesarean section, for example, sometimes have lower-than-normal scores, especially at one minute.

The five-minute Apgar score
The second score helps your practitioner see how your baby is progressing and whether he has responded to any initial medical intervention. A score of 7 to 10 is still considered normal at this point. If your baby scores 6 or less at the five-minute mark, he may need medical help and your practitioner will determine what steps need to be taken.

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