The first test most babies are given — and which most pass with good scores — is the Apgar test. Here’s what you need to know about your baby's Apgar test and scores.
What is the Apgar score?
The Apgar score is a simple assessment telling doctors your baby’s general condition based on observations in the first moments of life.This test is done to check whether your baby needs help breathing or is having heart problems.
Apgar is an acronym, standing for the following criteria:
- Appearance
- Pulse (heart rate)
- Grimace (reflexes)
- Activity (muscle tone)
- Respiration (breathing effort)
A pediatrician, OB/GYN, midwife or nurse will assign your newborn an Apgar score from 0 to 2 on each of the five criteria, with a total of 10 possible points. The higher the Apgar score, the better your baby is doing.
What is considered a normal Apgar score?
The Apgar test measures your baby's heart rate, breathing, muscle tone, reflex response and color in the first minutes of life.
- An Apgar score is 7 to 10means a newborn is in good to excellent health, usually only requiring routine post-delivery care.
- An Apgar score of 4 to 6 means a baby is in fair condition and may require some resuscitation measures.
- An Apgar score under 4 means a newborn is in poor condition and needs immediate medical attention.
How does the Apgar score work?
Here’s how the scoring works in Apgar tests:
Appearance/Skin Color
Is your baby’s skin pink (healthy) or blue (unhealthy)?
- Pale blue: 0
- Pink body, blue extremities: 1
- Pink all over: 2
Pulse/Heart Rate
Using a stethoscope, the doctor or nurse will listen to your baby’s heart.
- Heartbeat is not detectable: 0
- Heartbeat of fewer than 100 beats per minute: 1
- Heartbeat of 100 beats per minute or more: 2
Grimace/Reflexes
Reflex irritability, also called the grimace response, is how your baby reacts to stimulation like a light pinch (don’t worry, it doesn’t hurt).
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- No response to stimulation: 0
- Grimacing: 1
- Grimacing with a cough, sneeze, or lusty cry: 2
Activity/Muscle Tone
This category measures how much your baby is moving around.
- Loose, floppy or inactive muscles: 0
- Some movement of arms and legs: 1
- A lot of activity: 2
Respiration/Breathing Effort
Here the doctor, midwife or nurse will check how well your baby is breathing.
- No breathing: 0
- Slow or irregular breathing: 1
- Good breathing (crying): 2
Does a low Apgar score mean my baby won't be healthy?
While the Apgar test can tell a lot about your baby’s condition in the few minutes after birth, it doesn’t tell you much about anything long-term. In fact, even babies whose scores remain low at 5 minutes usually turn out to be completely healthy.
All babies get at least two Apgar scoresin thedelivery room. The first test will be done 1 minute after birth to see how well your newborn made it through the labor and delivery process.
At 5 minutes after birth, the test will be repeated to see how he’s doing now that he’s out in the world. Most low scores at 1 minute are normal 5 minutes later. Once in a while, a baby with a low score at 5 minutes may get tested again at the 10-minute mark.
If your baby gets a low Apgar score, she may need oxygen or to have her airway cleared out, or she may need some physical stimulation to get her heart rate up. Most of the time, a low Apgar score is the result ofdifficult birth, a C-sectionor fluid in the baby’s airway.
What else do I need to know?
The Apgar test was created in 1952 by anesthesiologist Virginia Apgar, M.D., to check whether babies needed resuscitation after their mothers got anesthesia during delivery. In the past, it was used to predict whether a baby would survive or have neurological problems, and doctors used it to diagnose asphyxia during birth.
Since then, research has shown that a baby’s Apgar score is not a good indicator of asphyxiation, and it doesn’t predict neurological issues in term or preterm babies. Today, your baby’s Apgar score isn’t considered a sign of anything other than how he’s doing during the first few minutes of life.
From the What to Expect editorial team andHeidi Murkoff,author ofWhat to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading ourmedical review and editorial policy.
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FAQs
The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed. Babies usually get the test twice: 1 minute after birth, and again 5 minutes after they're born.
What is a healthy Apgar score for a baby? ›
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.
How do you interpret Apgar scores? ›
The maximum possible score is a 10, while the lowest possible score is a 0. Medical professionals consider a score of 7 or higher to be a sign of good health, while a baby who scores under a 7 may require immediate medical care.
What is a 5 Apgar score for a baby? ›
When a newborn has an Apgar score of 5 or less at 5 minutes, umbilical artery blood gas from a clamped section of umbilical cord should be obtained. Submitting the placenta for pathologic examination may be valuable.
Does the Apgar score predict the future health of a baby? ›
Most of the time, a low score at 1 minute is near-normal by 5 minutes. Apgar scores are not usually measured after 5 minutes. A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.
What is the danger of a low Apgar score? ›
Newborns with low Apgar scores had higher rates of bradycardia, pneumothoraces, acidosis, and increased oxygen requirement during the first 6 to 8 hours of life. Maternal illness, complications of labor and delivery, and fetal heart rate decelerations did not correlate with subsequent Apgar scores of newborns.
What is a high risk Apgar score for a newborn? ›
Any score lower than 7 on the Apgar test is a sign that your baby may need medical attention. The lower the score, the more help your baby needs to adjust to life outside of your womb. Most low Apgar scores are caused by: High-risk pregnancy.
What is the highest Apgar score? ›
Doctors, midwives, or nurses add up these five factors for the Apgar score. Scores are between 10 and 0. Ten is the highest score possible, but few babies get it. That's because most babies' hands and feet remain blue until they have warmed up.
How common is an Apgar score of 9? ›
Data on IQ were available for 892 infants, on MABC-2 for 818 infants, and on ASQ-3 for 764 infants (Figure 1). Most infants had an Apgar score of 9 to 10 (306 individuals [33.3%]) or 7 to 8 (383 individuals [41.7%]), whereas 180 infants (19.6%) had scores of 4 to 6 and 49 infants (5.3%) had scores of 0 to 3 (Table 1).
What does a 3 at 1 minute Apgar score indicate? ›
The Apgar score is measured at 1 and 5 minutes and then at 10 and 20 minutes as resuscitative efforts are continued. A score of 0 to 3 indicates a severely depressed neonate, whereas a score of 7 to 10 is considered normal.
How Big Are Newborns? Newborns come in a range of healthy sizes. Most babies born between 37 and 40 weeks weigh somewhere between 5 pounds, 8 ounces (2,500 grams) and 8 pounds, 13 ounces (4,000 grams). Newborns who are lighter or heavier than the average baby are usually fine.
What is the cutoff for low birth weight? ›
Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces. Some babies with low birthweight are healthy, even though they're small. But having a low weight at birth can cause serious health problems for some babies.
What is the normal head circumference of a newborn? ›
The average head circumference at birth is about 34.5 cm (13.5 in.). By the end of the first month, it increases to about 37.6 cm (15 in.).
What are the disadvantages of the Apgar score? ›
Limitations of the Apgar Score
The Apgar score is a subjective assessment of the infant's physiologic status at a certain point in time. Maternal sedation or anaesthesia, congenital abnormalities, gestational age, trauma, and interobserver variability are all factors that can affect the Apgar score.
Do doctors still use Apgar score? ›
The Apgar score is a standardized assessment of a neonate's status immediately after birth and the response to resuscitation efforts and remains the gold standard for evaluating neonates.
What Apgar score indicates developmental difficulties? ›
The 5 min Apgar score is inversely associated with a risk of developmental vulnerability in early childhood across its entire range. There is an increased risk of developmental vulnerability among children with an Apgar score of 9, compared with children with a score of 10.
What does an Apgar score of 3 indicates that the baby is? ›
The Apgar score is measured at 1 and 5 minutes and then at 10 and 20 minutes as resuscitative efforts are continued. A score of 0 to 3 indicates a severely depressed neonate, whereas a score of 7 to 10 is considered normal.
What if a newborn's heart rate is less than 60? ›
If the heart rate is < 60 bpm, then support of the circulation by chest compression and positive pressure ventilation must be done. After about 30 seconds, evaluation is done again. If the heart rate is still < 60 bpm then epinephrine is administered along with continued PPV and chest compression.
