What Is the Apgar Score?

The Apgar score is a test given to newborns soon after birth. This test checks a baby's
heart rate, muscle tone, and other signs to see if extra medical care or emergency care
is needed.

The test is usually given twice: once at 1 minute after birth, and again at 5 minutes
after birth. Sometimes, if there are concerns about the baby's condition, the test may
be given again.

What Does "Apgar" Mean?

Apgar stands for "Appearance, Pulse, Grimace, Activity, and Respiration."

In the test, five things are used to check a baby's health. Each is scored on a scale of 0
to 2, with 2 being the best score:

1. Appearance (skin color)

2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)
Doctors, midwives, or nurses add up these five factors for the Apgar score. Scores are
between 10 and 0. Ten is the highest score possible, but few babies get it. That's
because most babies' hands and feet remain blue until they have warmed up.

Apgar Scoring
Apgar Sign          2        1      0
Normal color Normal Bluish-gray
all over color (but or pale all
(hands and hands and over
Appearance feet are feet are
(skin color) pink) bluish)

Normal Below 100 Absent

(above 100 beats per (no pulse)
Pulse beats per minute
(heart rate) minute)

Grimace Pulls away, Facial Absent (no

("reflex sneezes, movement response to
 coughs, or only stimulation)
cries with (grimace)
stimulation with
irritability") stimulation

Active, Arms and No

Activity spontaneous legs flexed movement,
(muscle movement with little "floppy"
tone) movement tone

Respiration Normal rate Slow or Absent (no

(breathing and effort, irregular breathing)
good cry breathing,
rate and
weak cry
effort)

What Does My Baby's Score Mean?

A baby who scores a 7 or above on the test is considered in good health. A lower score
does not mean that your baby is unhealthy. It means that your baby may need some
immediate medical care, such as suctioning of the airways or oxygen to help him or her
breathe better. Perfectly healthy babies sometimes have a lower-than-usual score,
especially in the first few minutes after birth.

A slightly low score (especially at 1 minute) is common, especially in babies born:

 after a high-risk pregnancy

 through a C-section
 after a complicated labor and delivery
 prematurely

At 5 minutes after birth, the test is given again. If a baby's score was low at first and
hasn't improved, or there are other concerns, the doctors and nurses will continue any
necessary medical care. The baby will be monitored closely.

What if My Baby Has a Low Score?

Many babies with low scores are perfectly healthy and do just fine after adjusting to life
outside the womb.
If your doctor or midwife is concerned about your baby's score, he or she will let you
know and will explain how your baby is doing, what might be causing problems (if any),
and what care is being given.

What Else Do I Need to Know?

This test was not designed to predict a baby's long-term health, behavior, intelligence,
personality, or outcome. It was designed to help health care providers tell a newborn's
overall physical condition so that they could quickly decide whether the baby needed
immediate medical care.

With time to adjust to the new environment and with any necessary medical care, most
babies do very well. So rather than focusing on a number, just enjoy your new baby!

Keeping Your Baby Warm

Babies can't adjust to temperature changes as well as adults. Babies can lose heat
rapidly, nearly 4 times faster than an adult. Premature and low-birthweight babies don't
have much body fat. Their bodies may not be ready to control their own temperature,
even in a warm environment. Even full-term and healthy newborns may not be able
to keep their body warm if the environment is too cold.
When your baby gets too cold, he or she uses energy and oxygen to generate warmth.
If his or her skin temperatures drops just 1 degree from the ideal 97.7° F
(36.5°C), your baby's oxygen use can increase by 10%. Keeping your baby at a
temperature, which is neither too hot nor too cold, helps him or her hold onto
that energy and build up reserves. This is even more important if your baby is sick or
premature.

Ways to keep babies warm

Ways to keep your babies warm are:
 Drying and warming your baby right after birth. Wet skin can cause your
baby to lose heat quickly by evaporation. He or she can quickly lose 2° to 3°F. It
is important to warm and dry your baby right away using warm blankets and
skin-to-skin contact. Another source of warmth such as a heat lamp or over-bed
warmer, may also be used.
 Open bed with radiant warmer. An open bed with radiant warmer is open to
the room air and has a radiant warmer above. A temperature probe on the baby
connects to the warmer. This tells the warmer what your baby's temperature is
so it can adjust automatically. When the baby is cool, the heat increases. Open
beds are often used in the delivery room for rapid warming. They are also used
 right away in the NICU and for sick babies who need constant attention and
care.

 Incubator/isolette. Incubators are walled plastic boxes with a heating system

to circulate warmth.
Babies will usually start out dressed only in a diaper while the heat is fully on. As the
heat level is gradually reduced, more clothing is added. Once your baby is stable and
can maintain his or her own body temperature without added heat, he or she is placed
in an open crib or bassinet. Your baby will likely be dressed in a gown or T-shirt, a
diaper, and possibly a hat. Often, a blanket or sleep sack is wrapped securely around
the baby. This is called swaddling.
To lower the risk for sudden infant death syndrome (SIDS), the American Academy of
Pediatrics advises that parents and caregivers not overbundle, overdress, or cover an
infant's face or head. This is to prevent your baby from getting overheated. In addition,
there should be no extra blankets or toys in the bed because they could block the
baby's breathing.

Suctioning
According to a research by Kelleher J, Bhat, R, Salas AA, et al., a healthy neonate is
born through clear amniotic fluid with no meconium. She is vigorous and has no major
congenital anomalies. Does she need oronasopharyngeal suctioning?

No, she does not need suctioning. Although it is still standard practice to perform
oronasopharyngeal suctioning with a bulb syringe immediately after delivery, multiple
studies have found no benefit to routine suctioning. Guidelines from the Neonatal
Resuscitation Program (NRP) and other organizations recommend against the practice,
even for neonates born through meconium-stained amniotic fluid. Suctioning is done
because some clinicians believe it reduces the risk of aspiration, especially if there is
meconium, and to stimulate breathing, but the evidence suggests that suctioning can
stimulate the vagus nerve, which can lead to bradycardia. Studies that compared babies
who did and didn’t receive suctioning found that those who received it had lower Apgar
scores and oxygen saturation levels.

Transfer to Nursery

After giving the initial care for the newborn, once stabilize, the baby will be transferred
to the Nursery Intensive Care Unit to continuously monitor the condition of the newborn
until it will be room-in with the mother. Usually the transfer is easy and fast, because
the NICU was just adjacent to the Operating Room or Delivery Room in a hospital
setting. In the event that the said facilities are far from the NICU, Healthcare providers
should keep a sterile environment for the newborn while transporting.