APGAR Score

Excerpt

The Apgar score is a rapid method for assessing a neonate immediately after birth and in response to resuscitation. Apgar scoring remains the accepted assessment method endorsed by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. While originally designed in 1952 by Dr. Virginia Apgar, an anesthesiologist at Columbia University, to assess the need for intervention to establish breathing at 1 minute, the guidelines for the Neonatal Resuscitation Program state that Apgar scores should not be used to determine the initial need for intervention, what interventions are indicated, or when to initiate them, as resuscitation must be commenced before the 1-minute Apgar score is assigned.

Elements of the Apgar score include color, heart rate, reflexes, muscle tone, and respiration. Apgar scoring is designed to assess for signs of hemodynamic compromise, including cyanosis, hypoperfusion, bradycardia, hypotonia, respiratory depression, or apnea. Each element is scored 0, 1, or 2. The score is recorded at 1 minute and 5 minutes after delivery in all infants, with expanded recording at 5-minute intervals for infants who score ≤7 at 5 minutes and in those requiring resuscitation as a method for monitoring response; scores of 7 to 10 are considered reassuring.

Apgar scores may vary with gestational age, birth weight, maternal medications, drug use or anesthesia, and congenital anomalies. Several components of the score are also subjective and prone to inter-rater variability. Thus, the Apgar score is limited because it provides somewhat subjective information about an infant’s physiology at a point in time. Apgar score alone should not be interpreted as evidence of asphyxia, and its significance in outcome studies, while widely reported, is often inappropriate. Resuscitation should always take precedence over calculating a clinical score.