APGAR Score Calculator

How does this APGAR score calculator work?

This is a health tool that allows clinicians and not only to assess the condition of an infant at 1 and 5 minutes after delivery in terms of some clinical variables established by Dr. Apgar back in 1953. This is a well renowned neonatology study that has gained its popularity in time and is nowadays used in all birth departments to evaluate physical condition first hand.

The acronym comes from both Dr. Virginia Apgar, the anaesthesiologist who created the testing method but also from the initials of the five criteria: Appearance, Pulse, Grimace, Activity and Respiration.

The 1 minute evaluation checks how the new born tolerated the birth process while the second evaluation, the one at 5 minutes checks how the baby accommodated outside of the womb. In some cases, very rarely, even a third testing at 10 minutes is employed.

One of the medical professionals being present at the delivery will perform the two tests, be it the doctor, a nurse or the midwife. The criteria they look at is presented below and each answer is awarded a number of points, from 0 to 2 based on observation:

■ Activity/Muscle Tone – assesses the mobility and the muscular state of the infant. There are three results to this assessment, active motion, some muscle tone and flexions or no muscle tone, floppy muscles.

■ Pulse – The heart rate of the infant is tested through the stethoscope evaluation and the reference value is set at 100 beats per minute. This is the most basic investigation to show whether the new born has any heart problems.

■ Grimace/Reflex irritability – grimace response to mild pinching, external stimulation assessed whether the infant sneezes, cries vigorously or if there is little or no grimace reaction.

■ Appearance/Skin color – the aspect of the infant’s skin, either pink, partially blue or totally blue.

■ Respiration/Breathing effort – checks for respiratory issues and whether the infant breathes normally and cries or if the breathing is slowed, irregular or even not present.

APGAR score chart and interpretation

It is important that the score is assessed 1 minute and then 5 minutes after birth and both scores to be registered. APGAR varies between 0 and 10, 10 being the best condition in all five criteria.

Scores of 7 and above are considered normal while scores below suggest that the infant needs assistance adapting outside the womb and are said to request more medical attention and have a potential to need interventions such as suction, warming or supplemental oxygen. The three most common low APGAR score causes are a difficult birth, in cases where the infant’s airways are blocked by fluid or in C-sections. And often, a baby might have a lower score at the 1 minute test and then a normal score at the 5 minute testing.

However, the most common scores are 7, 8 and 9 with 10 being a rare occurrence as most new born have extremities still bluish and receive only 1 point out of 2 for the skin appearance assessment.

Some clinicians mention a connection between the score the baby obtains and the situation of the pregnancy or the mother’s weight or the connection with the birth respecting or not the due date but further evidence is to be given in regard to that.

What most new parents need to understand is that the APGAR score is a temporary evaluation and has no predictability in the future health of the baby and doesn’t necessary mean that the baby will have any long term illnesses and doesn’t predict intellect, personality or behavioural patterns.

References

1) Apgar V. (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg; 32(4):260-7.

2) Apgar V. (1966) The newborn (Apgar) scoring system. Reflections and advice. Pediatr Clin North Am; 13(3):645-50.

3) Finster M, Wood M. (2005) The Apgar score has survived the test of time. Anesthesiology; 102(4):855-7.

4) Casey BM, McIntire DD, Leveno KJ. (2001) The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med; 344(7):467-71.