APGAR

INTRODUCTION
• First described in 1952 by Dr. Virginia APGAR,
anesthetist .
• Soranus of Ephesius ,a greek physician ,18
centuries earlier, “soranus score” , heart rate
was not included.
• Jeffrey S. Crawford ,British Obstetric Anesthetist
, A-C( APGAR minus Colour) ,max 8 points , not
widely accepted ,even though it reflect drug
effects in the neonate.
• Rapid method for assessing clinical status of
newborn infant.
• APGAR score provides an acceptable and
convenient method for reporting status of
newborn immediately after birth.
• Does not predict individual neonatal mortality
or neurological outcome.
 APGAR SCORE
0 1 2

APPEARANCE/COLO Blue/ pale Acrocyanotic Completely pink

UR

HEART RATE Absent < 100 > 100

REfLEX IRRITABILITY No response Grimace Cry and active

MUSCLE TONE Limp Some lexion Active movements

RESPIRATION Absent Weak cry Good cry

 RECOMMENDATIONS
• Apgar score – doesnot predict individual
neonatal mortality and neurological outcome.
• It is inappropriate to use apgar score alone to
establish the diagnosis of asphyxia.
• Perinatal health care professionals should be
consistent in assigning an apgar score during
resuscitation.
AAP and ACOG recommends use of expanded
APGAR score.
 Limitations

• Factors that can influence the APGAR score

• maternal sedation or anesthesia
• congenital malormations
• gestational age
• trauma
• interobserver variability
• Tone,colour and reflex irritability can be
subjective and partially depend on the
physiologic maturity of the infant.
• Can be affected by variations in normal
transition.
• 1. Low saturation at birth 60 to 65% @1 min, 80
to 85 %@5min
• 2. Physiological immaturity in preterm neonates
can be misinterpreted as asphyxia.
• The incidence of low APGAR scores is inversely
related to birth weight
• Low scores cannot predict mortality.
• APGAR score alone should not be used to
diagnose asphyxia .
 Prediction of outcome
• APGAR score of 0-3@ 1min does not predict
any individual infant’s outcome.
• APGAR score of 0-3 @5 min – does not
predict individual future neurologic
dysfunction but can predict mortality.
• Recent reports suggest that low apgar score at
5 min is associated with increased risk of
cerebral palsy
• Apgar score <3 at 10,15,20 min increases risk
for poor neurological outcome
• Apgar score <5 at 5 min send for umbilical
ABG.