The apgar score: Simple yet complex

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The purpose and use of the Apgar score in clinical care has been questioned in the past and continues to be questioned today. The Apgar score, when done correctly, gives the clinician a picture of the infant at two different periods of time, four minutes apart. After a baby is born, the physician asks, "What is the Apgar?" The Apgar score has been used by lawyers to sue obstetricians. The parents often ask also, "What is the Apgar?" The Apgar score has been used by physicians to predict survival or possible handicap. The Apgar score is used around the world.So what is the purpose of the Apgar score? It provides the clinician with information. An initial low Apgar can tell the clinician that the infant was stressed in utero or endured a hypoxic or ischemic episode. The second Apgar score can provide information on how the infant responded to a skilled resuscitation. This provides additional information on the infant's present condition and will help the clinician manage the care of every newborn. Infants with lower Apgar scores require closer observation and may be at risk for ischemic injury. Infants with high Apgar scores are at less risk of death or morbidity. There are many individual factors that affect the Apgar score, including the skill of the evaluator, the maturity of the infant, maternal medications, and the need for resuscitation. The imprecision of the Apgar scoring is a limitation of any predictive abilities of the tool. The scoring criteria are based on absent to present. The low score is absent, and the high score is present. The score of 1 is when the evaluator scores the criteria as somewhere in the middle. If the evaluators consider this when performing the scoring assessment, it may improve the reliability of the scoring system. Some of the confusion about Apgar scores is over the many terms that have been used over the years to describe the different criteria. The various terms used to describe infants are listed in the Apgar score chart (see Table 1). Most score sheets list only one or two of the terms, and it varies with facility and country. The expanded Apgar scoring has some advantages in that the clinician can document the reasoning behind the scores. It includes the resuscitation efforts with the score and trends it over time (20 minutes). The 20- minute Apgar scoring chart (see Figure 2) has a quick check-box for each Apgar criteria, oximeter reading, and treatments given. The sheet would be a record of the infant's condition over time, and the resuscitation efforts given for the initial 20 minutes of life. This checklist could be used for preterm infants or those requiring resuscitation. Consistency in scoring can make the= Apgar score a useful tool for assessing an infant's condition at birth. Research should be done on ways to improve the scoring inconsistencies to improve our risk assessments at birth.

Original languageEnglish (US)
Pages (from-to)169-177
Number of pages9
JournalNeonatal Network
Issue number3
StatePublished - Jan 1 2012

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care
  • Critical Care and Intensive Care Medicine


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