University of San Agustin

General Luna St., Iloilo City 5000, Philippines

www.usa.edu.ph
COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM

APGAR SCORING
In 1952, Dr. Virginia Apgar devised a scoring system that was a rapid method of
assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt
intervention to establish breathing .

The Apgar score provides a convenient shorthand for reporting the status of the
newborn infant and the response to resuscitation. The Apgar score has been used
inappropriately to predict specific neurologic outcome in the term infant. There are no consistent
data on the significance of the Apgar score in preterm infants (American Academy of Pediatrics,
2006)

At 1 minute and 5 minutes after birth, newborns are observed and rated according to an
Apgar score, an assessment scale used as a standard for newborn evaluation since 1958
(Apgar, Holaday, James, et al., 1958).

This scoring system provided a standardized assessment for infants after delivery. The
Apgar score comprises five components: 1) color, 2) heart rate, 3) reflexes, 4) muscle tone, and
5) respiration, each of which is given a score of 0, 1, or 2. Thus, the Apgar score quantitates
clinical signs of neonatal depression such as cyanosis or pallor, bradycardia, depressed reflex
response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at
1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20
minutes for infants with a score less than 7

A Legacy of Excellent Education in Virtus et Scientia

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 University of San Agustin
General Luna St., Iloilo City 5000, Philippines
www.usa.edu.ph
COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM

Heart Rate
Auscultating a newborn heart with a stethoscope is the best way to determine heart rate;
however, heart rate also may be obtained by observing and counting the pulsations of the
umbilical cord at the abdomen if the cord is still uncut.

Respiratory Effort
Respirations are counted by observing chest movements. A mature newborn usually cries and
aerates the lungs spontaneously at about 30 seconds after birth. By 1 minute, he or she is
maintaining regular, although rapid, respirations. Difficulty with breathing might be anticipated in
a newborn whose mother received large amounts of analgesia or general anesthetic during
labor or birth.

Muscle Tone
Term newborns hold their extremities tightly flexed, simulating their intrauterine position. Muscle
tone is tested by observing their resistance to any effort to extend their extremities.

Reflex Irritability
One of two possible cues is used to evaluate reflex irritability: response to a suction catheter in
the nostrils or response to having the soles of the feet slapped. A baby whose mother was
heavily sedated for birth will probably demonstrate a low score in this category.

Color
All infants appear cyanotic at the moment of birth. They grow pink with or shortly after the first
breath, which makes the color of newborns correspond to how well they are breathing.
Acrocyanosis (cyanosis of the hands and feet) is so common in newborns that a score of 1 in
this category can be thought of as normal.

The Respiratory Evaluation

Good respiratory function has the highest priority in newborn care, so the assessment for it is
ongoing at every newborn contact. The Silverman-Andersen index, originally devised in 1956
(Silverman & Andersen, 1956), is a standard method, which can be used to estimate degrees of
respiratory distress in newborns.

A Legacy of Excellent Education in Virtus et Scientia

Email: info@usa.edu.ph | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan
 University of San Agustin
General Luna St., Iloilo City 5000, Philippines
www.usa.edu.ph
COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS-NURSING PROGRAM

Watch a video clip on APGAR scoring using the links:

https://www.youtube.com/watch?v=iw6GYQ7bDsY
https://www.youtube.com/watch?v=cQKaTCMFjwc
https://www.youtube.com/watch?v=X48lqTNUTQk

A Legacy of Excellent Education in Virtus et Scientia

Email: info@usa.edu.ph | Tel. No.: (033) 337-4841 to 44 | Fax No.: (033) 337-4403 jilamasan