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APGAR SCORE

The original Apgar score was devised by Virginia Apgar, MD, an anesthesiologist, in 1952 who invented a scoring system to assess the clinical status of the newborn infant and the need for medical intervention to establish breathing at 1 minute of age. It was presented at a national anesthesiology meeting in 1952. She published the results in 1953 in a paper titled, “A Proposal for a New Method of Evaluation of the Newborn Infant,” the purpose of which was to establish a grading system of newborns to be used as a basis to discuss and compare results of obstetric practices, different types of maternal pain relief, and the effects of resuscitation techniques. It was “a simple clear classification or grading of newborns consisting of five signs” that did not require special equipment, were determined easily, did not interfere with the care of the newborn, and could be taught without difficulty. She chose heart rate, respiratory effort, reflex irritability, muscle tone, and color. The most important sign was the heart rate, followed by respiratory rate, and the least important sign was the color of the newborn. A rating of 0, 1, or 2 was given for each sign at 60 seconds after delivery (after the complete birth of the baby and the time of maximal clinical depression after birth). Two subsequent studies were done (1952–1956 and 1959–1966), and the 5-minute Apgar score was added because neonatal mortality strongly correlated with it. In 1962, a “back acronym” (APGAR) was created from Dr. Apgar’s last name by 2 pediatricians to help teach the 5 signs of the Apgar score: A: appearance (color); P: pulse; G: grimace (response to stimulation); A: activity (tone); R: respiration.

EXPANDED APGAR SCORE

In 2015, the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) published a statement that included the second edition of the Neonatal Encephalopathy and Neurologic Outcome about the purpose of the Apgar score because many were using the score inappropriately. They recommended the new expanded Apgar score (Figure B–1). It has the same 5 signs as the original Apgar score but includes reporting a score also at 10, 15, and 20 minutes (10-, 15-, and 20-minute assessment is recommended by the American Heart Association [AHA] if the 5-minute Apgar score is <7) with added room to record (by a checkmark) if any of the following are used: oxygen, positive-pressure ventilation/nasal continuous positive airway pressure, endotracheal tube, chest compressions, and epinephrine. This new score accounts for resuscitative interventions. The definitions from the Neonatal Encephalopathy and Neurologic Outcome report that are recommended for the 5-minute Apgar score for term and late preterm infants are as follows: score of 7 to 10, reassuring; score of 4 to 6, moderately abnormal; and score of 0 to 3, low. The AAP and ACOG recommend an umbilical arterial blood gas sample from a clamped section of the umbilical cord and possibly submitting the placenta for examination by pathology if the infant has an Apgar score of 5 at <5 minutes. Below is a summary of what the Apgar score does and does not do based on the AAP 2015 Policy Statement and the ACOG Task Force on Neonatal Encephalopathy.

FIGURE B–1.

Expanded Apgar score reporting form. Scores should be recorded in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported by using a checkmark in ...

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