Apgar score
Encyclopedia
The Apgar score was devised in 1952 by the eponymous Dr. Virginia Apgar
Virginia Apgar
Virginia Apgar was an American pediatric anesthesiologist. She was a leader in the fields of anesthesiology and teratology, and effectively founded the field of neonatology...

 as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after birth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...

. Apgar was an anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....

 who developed the score in order to ascertain the effects of obstetric
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...

 anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 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 are summarized using words chosen to form a backronym
Backronym
A backronym or bacronym is a phrase constructed purposely, such that an acronym can be formed to a specific desired word. Backronyms may be invented with serious or humorous intent, or may be a type of false or folk etymology....

 (Appearance, Pulse, Grimace, Activity, Respiration.)

Criteria

Score of 0 Score of 1 Score of 2 Component of backronym
Skin color/Complexion
Complexion
Complexion refers to the natural color, texture, and appearance of the skin, especially that of the face.-History:The word "complexion" is derived from the Late Latin complexi, which initially referred in general terms to a combination of things, and later in physiological terms, to the balance of...

blue or pale all over blue at extremities
body pink
(acrocyanosis
Acrocyanosis
Acrocyanosis is persistent blue or cyanotic discoloration of the extremities, most commonly occurring in the hands, although it also occurs in the feet and distal parts of face....

)
no cyanosis
Cyanosis
Cyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...


body and extremities pink
Appearance
Pulse rate Absent <100 ≥100 Pulse
Reflex
Reflex
A reflex action, also known as a reflex, is an involuntary and nearly instantaneous movement in response to a stimulus. A true reflex is a behavior which is mediated via the reflex arc; this does not apply to casual uses of the term 'reflex'.-See also:...

 irritability
no response to stimulation grimace/feeble cry when stimulated cry or pull away when stimulated Grimace
Muscle tone
Muscle tone
In physiology, medicine, and anatomy, muscle tone is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state. It helps maintain posture, and it declines during REM sleep.-Purpose:Unconscious nerve impulses maintain the...

none some flexion
Flexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...

flexed arms and legs that resist extension Activity
Breathing
Breathing
Breathing is the process that moves air in and out of the lungs. Aerobic organisms require oxygen to release energy via respiration, in the form of the metabolism of energy-rich molecules such as glucose. Breathing is only one process that delivers oxygen to where it is needed in the body and...

absent weak, irregular, gasping strong, lusty cry Respiration
The five criteria of the Apgar score:

Interpretation of scores

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 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
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...

 damage. There is also a small but significant increase of the risk of cerebral palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....

. 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.

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
Pulse oximetry
Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot....

) also was lower at high altitude.

Backronym

Some ten years after the initial publication, a backronym
Backronym
A backronym or bacronym is a phrase constructed purposely, such that an acronym can be formed to a specific desired word. Backronyms may be invented with serious or humorous intent, or may be a type of false or folk etymology....

 for APGAR was coined in the US as a mnemonic
Mnemonic
A mnemonic , or mnemonic device, is any learning technique that aids memory. To improve long term memory, mnemonic systems are used to make memorization easier. Commonly encountered mnemonics are often verbal, such as a very short poem or a special word used to help a person remember something,...

 learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. In German, the words Atmung, Puls, Grundtonus, Aussehen, Reflexe were used; in Spanish, Apariencia, Pulso, Gesticulación, Actividad, Respiración; and, in French, Apparence, Pouls, Grimace, Activité, Respiration.

Another case where Dr. Apgar's name is eponym
Eponym
An eponym is the name of a person or thing, whether real or fictitious, after which a particular place, tribe, era, discovery, or other item is named or thought to be named...

ous for a backronym is American Pediatric Gross Assessment Record.

Another mnemonic devised for the test is to use the phrase “How Ready Is This Child”, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.

See also

  • Glasgow Coma Scale
    Glasgow Coma Scale
    Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment...

  • Pediatric Glasgow Coma Scale
    Pediatric Glasgow Coma Scale
    The Paediatric Glasgow Coma Scale is the equivalent of the Glasgow Coma Scale used to assess the mental state of adult patients. As many of the assessments for an adult patient would not be appropriate for infants, the scale was modified slightly...

  • Ballard Maturational Assessment
    Ballard Maturational Assessment
    The Ballard Maturational Assessment, Ballard Score, or Ballard Scale is a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby. These criteria are divided into Physical and...

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