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File:Virginia Apgar.jpg

The Apgar score was devised in 1952 by Dr. Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth.[1][2] Apgar was an anesthesiologist who developed the score in order to ascertain the effects of obstetric anesthesia on babies.

The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria (Appearance, Pulse, Grimace, Activity, Respiration) are used as a mnemonic learning aid.


Score of 0 Score of 1 Score of 2 Component of acronym
Skin color/Complexion blue or pale all overblue at extremities
body pink
no cyanosis
body and extremities pink
Pulse rate 0 <100≥100 Pulse
Reflex irritability no response to stimulation grimace/feeble cry when stimulated cry or pull away when stimulated Grimace
Muscle tone nonesome flexion flexed arms and legs that resist extension Activity
Breathing absentweak, irregular, gaspingstrong, lusty cry Respiration
The five criteria of the Apgar score:

Interpretation of scoresEdit

The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal.

A low score on the one-minute test may show that the neonate requires medical attention[3] but is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-term neurological damage. There is also a small but significant increase of the risk of cerebral palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long-term predictions on a child's health.[1]

A score of 10 is uncommon due to the prevalence of transient cyanosis, and is not substantially different from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study comparing babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant difference in the first but not the second Apgar score. Oxygen saturation (see Pulse oximetry) also was lower at high altitude.[4]


Some ten years after the initial publication, the acronym APGAR was coined in the US as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. The same acronym is used in German (Atmung, Puls, Grundtonus, Aussehen, Reflexe), Spanish (Apariencia, Pulso, Gesticulación, Actividad, Respiración) and French (Apparence, Pouls, Grimace, Activité, Respiration) although the letters have different meanings.

Another such backformation attempting to make Apgar an acronym is American Pediatric Gross Assessment Record. The test, however, is named for Dr. Apgar, making Apgar an eponymous backronym.

The test has also been reformulated with a different mnemonic, How Ready Is This Child, but the criteria are the same: Heart rate, Respiratory effort, Irritabililty, Tone, and Color.

See alsoEdit


  1. 1.0 1.1 Apgar, Virginia (1953). A proposal for a new method of evaluation of the newborn infant. Curr. Res. Anesth. Analg. 32 (4): 260–267.
  2. Finster M, Wood M. (April 2005). The Apgar score has survived the test of time. Anesthesiology 102 (4): 855–857.
  3. Casey BM, McIntire DD, Leveno KJ (February 15, 2001). The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 344 (7): 467–471.
  4. Gonzales GF, Salirrosas A (2005). Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m). Reproductive Biology and Endocrinology : RB&E 3: 46.
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