CPMS COLLEGE OF

NURSING

ASSIGNMENT
ON
APGAR SCORE

DATED: 28th MAY, 2021

SUBJECT: CHILD HEALTH NURSING

SUBMITTED TO SUBMITTED BY:

MAAM ARCHANA DAS AMY LALRINGHLUANI
ASSOCIATE PROFESSOR M.Sc. (N) 1ST YEAR
M.Sc. (N) CHILD HEALTH NURSING CPMS CON
CPMS CON
INTRODUCTION
The APGAR test is one that measures the well-being of a baby shortly after birth. Virginia
Apgar developed the test in 1952, and since then, it has become a standard test for most
newborns. Medical professionals use this assessment to quickly relay the status of a
newborn’s overall condition. Low Apgar scores may indicate the baby needs special care,
such as extra help with their breathing.

DEFINITION
The Apgar score is a scoring system doctors and nurses use to assess newborns one minute
and five minutes after they’re born.
The Apgar score is
 The baby’s first test
 A quick assessment of the baby’s overall well-being
 Given one minute after birth and five minutes after birth
 Rates five vital areas - Heart rate, Respiratory effort, Muscle tone, Reflex irritability
and Color

CRITERIA/INDICATORS OF APGAR SCORING

Acrony Meaning
m
A Appearance (skin color)
P Pulse ( heart rate)
G Grimace (reflex response)
A Activity ( muscle tone)
R Respiration (Breathing)

PURPOSE
 The Apgar score describes the condition of the newborn infant immediately after birth
 It is a tool for standardized assessment
 It provides a mechanism to record fetal-to-neonatal transition.
 Apgar scores do not predict individual mortality or adverse neurologic outcome

INDICATION
 All newborns at 1 minute and 5 minutes following delivery

PROCEDURE

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 Using the table provided below, the newborn is assigned a score (0-2) for each of the
five criteria at 1 minute and again at 5 minutes following delivery.
All the individual scores are added to calculate the total APGAR score (0-10)

APGAR SCORE
Criteria Action Score 0 Score 1 Score 2
Appearance Look at skin Blue/ Pale all Pink in body, Entire body
color over Extremities blue pink/no blue
Pulse Count heart No pulse Below 100 bpm Above 100 bpm
rate
Grimace Monitor No response to Facial movement Sneezing,
response stimulation (grimace) when vigorous cry or
stimulated pulling away
when
stimulated
Activity Look at muscle Limp/No Some extension and Active
tone movement flexion movement
Respiration Count and No breathing Slow/weak/irregular Strong cry
assess breathing
breathing

1: Appearance
The first category is appearance. In this part of the test, the medical staff will look at the
baby's skin color. The skin color can indicate whether the baby is receiving enough oxygen or
not.
A zero in this category means the baby is blue all over.

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 A one means the baby is mostly a healthy color but may be bluish at the hands and
feet.
A two means the baby is a healthy color all over, including pink at the hands and feet.
2: Pulse
The next category on the APGAR test is heart rate. A nurse, doctor, or midwife will check for
the baby's heartbeat. The medical staff will also determine the pulse rate to see how the baby
is thriving.
If the baby doesn't have a heart rate, the score is zero.
A score of one indicates a heart rate under 100 beats per minute, which is not quite as
fast as it should be.
A score of two indicates the baby's heart rate is over 100, which means the baby is
thriving in this particular category.
3: Grimace
The grimace response is how the baby reacts to mild stimulus. For instance, the baby may be
lightly pinched to see if the baby responds a lot or if it doesn't respond at all to the stimulus.
A zero indicates no response.
A one means the baby pulls a face (grimaces) but doesn't sneeze or cough.
A two means the baby pulls a face and either cries, pulls away, sneezes, or coughs in
response.
4: Activity
Next comes a check of activity (muscle tone). Muscle tone just measures the baby's activity
to see if it is moving around on its own. An active baby indicates that they are doing well.
A zero indicates the baby is limp or not moving much at all.
If the baby is given a one, it means they are moving with smaller or less active
motions, but they are not as vigorous as the doctor would prefer.
A two means the baby is actively moving around.
5: Respiration
The last category on the APGAR test is breathing. A person on the medical staff examines
the baby to see how they're breathing, then assigns a number to the breathing effort from zero
to two based on what they observe.
A zero means the baby is not breathing
one means the baby has irregular breathing.
A two means is the baby is breathing just fine, which usually means the baby is both
breathing and crying with normal effort and at a normal rate.

TIMING AND POSITIONING OF THE TEST

1. Where the test will be performed.
o Generally, the baby will be placed somewhere warm while the test is
performed.
o That can either be on a parent's belly or under a warmer.
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 o Keeping the baby warm is important.

2. The one-minute test.

o As the name implies, the one-minute test is performed a minute after the baby
leaves the mother's body.
o It tells the medical staff how well the baby did during the birthing process and
accesses the baby's need for assistance.

3. The five-minute test.

o The five-minute test, as it sounds, is given five minutes after birth.
o This test is the same as the one-minute test
o It is given to measure how the baby is doing out in the world (out of the
womb).
o This test also helps evaluate whether any interventions are working.

4. The third test.

o While the test is usually just performed twice, it may be given a third time if
the baby has a low score.
o Usually, it's given at the ten minute mark to see if the baby has improved any
from the five-minute test.

INTERPRATATION OF SCORE
The score from the APGAR is generally taken as a whole rather than in individual categories.
In other words, all the scores from each category are added together to get one number. The
best possible score is ten, which means the baby is doing as well as they can be. However,
most babies don't score a ten at birth.
A score from seven to ten means the baby will just need standard care.
If the score is under seven, the baby will need more monitoring and possibly
interventions, such as help breathing.

SCORE INTERPRETATION

0-3 Severely depressed

4-7 Moderately depressed

8-10 Good adjustment to extra uterine life

INTERVENTIONS FROM THE MEDICAL TEAM

If the baby has a low score, generally one of two things will happen. With the first
intervention, the baby's airway will be cleared out if it has fluid, and the baby will be given
oxygen. A second option is the baby may be given stimulation to get the heart beating more
rapidly.
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 SCORE INTERVENTION INTENSIVE CARE UNIT
0-3  Intensive resuscitation Requires Intensive care Unit
 CPR
 Ventilation with 100% oxygen
 Intubation
 Parenteral support
 Maintenance of body temperature
4-7  Airway clearance May require Intensive care unit
 Gentle stimulation
 Ventilate with Oxygen until stable
 Suction
 Careful observation
8-10 Rarely needs resuscitation Does not require Intensive unit

EXAMPLE OF APGAR SCORE SHEET:

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