When calculating the Apgar score of a newborn which would the nurse assess in addition to the heart rate?

The newborn Apgar score is a quick way for your baby’s healthcare providers to assess your baby’s well-being immediately after birth. The Apgar score is a standard method used to determine if your baby needs immediate medical care. Your baby may need help breathing, may be having heart trouble or may have other medical needs related to transitioning from life in the womb.

Your baby’s healthcare providers don’t use the Apgar score to predict your baby’s future development, intelligence or future health. The Apgar tests can’t be used to determine if your baby will have serious or long-term health issues. The Apgar score simply alerts your baby’s healthcare providers if your baby needs a little extra assistance immediately after birth.

When is the Apgar score performed?

The Apgar score is performed at one minute after your baby’s birth and at five minutes after their birth. The score at one minute assesses how well your newborn tolerated the birth process. The score at five minutes tells your baby’s healthcare providers how well your baby is transitioning to life outside of your womb. Rarely, the Apgar test is performed at 10 minutes after birth as well. This is only done if the Apgar score is less than 7 at 10 minutes.

Who performs the Apgar tests?

As soon as your baby is born, a labor and delivery nurse will set a timer for one minute and set another timer for five minutes. After each timer goes off, a physician, midwife, nurse or another healthcare provider will perform the Apgar tests.

Your baby’s Apgar score is based on five factors. Your baby’s healthcare provider will give your baby 0, 1 or 2 points based on their condition in each category of the Apgar test. The points are added up for a total possible score of 10. Apgar stands for Appearance, Pulse, Grimace, Activity and Respiration:

• A — Appearance: Your baby’s healthcare provider will look at your baby’s skin tone or color. Newborns don’t start circulating oxygen-rich blood until after they’re born and have taken their first breath. Oxygen-rich blood is what makes babies turn from a bluish tone to a more pink color.
• P — Pulse: Your baby’s healthcare provider will check your baby’s pulse. This is a measure of your baby’s heart rate and their ability to pump blood.
• G — Grimace: Grimace is your baby’s reaction to stimulation. It’s also called reflex irritability. Your baby’s healthcare provider will determine grimace by suctioning your baby’s nose or mouth.
• A — Activity: Activity is a measure of your baby’s muscle tone or movement. Your baby’s healthcare provider will look at the amount of movement in your baby’s arms and legs.
• R — Respiration: Respiration is classified by your baby’s breathing effort. It’s determined by how much and how loudly your baby cries.

The Apgar scoring assessment is based on the Apgar score chart:

What happens during the Apgar test?

Your baby’s healthcare provider will do a quick evaluation of the five factors of the Apgar test, including:

• Examine your baby’s skin color and muscle tone.
• Listen for crying.
• Use a stethoscope to listen to your baby’s heart rate.
• Suction your baby’s nose or mouth to test their reflexes.

Your baby’s Apgar score will range from 0 to 10. The higher your baby’s Apgar score, the better they’re doing after birth. Most newborns score 7, 8 or 9 on the Apgar test. A score of 7 or higher is considered a good Apgar score. Very few newborns score a perfect 10 because it takes a while for their hands and feet to warm up and turn pink. About 90% of infants have Apgar scores of 7 to 10.

What happens if the Apgar score is low?

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:

If your baby has a low Apgar score, it doesn’t mean they’ll have serious or long-term health conditions. In fact, the Apgar score isn’t meant to predict your baby’s future health at all. However, immediately after birth, your baby may need:

• Suctioning: Your baby may need help clearing their airway to help them breathe.
• Oxygen: Your baby may need oxygen. A mask may be placed over your baby’s face to give them oxygen. If your baby isn’t breathing on their own within a few minutes, their healthcare provider may place a tube in your baby’s windpipe.
• Physical stimulation: Your baby’s healthcare provider may stimulate and dry your baby to get their heart beating at a regular rate.
• Other interventions: They may give your baby fluids and medications through a blood vessel in their umbilical cord to strengthen their heartbeat as well.

With these treatments, most low Apgar scores at one minute will be close to normal at the five-minute Apgar test. If your baby’s Apgar score is still low after these treatments, they’ll be taken to a special newborn (neonatal) unit for more intensive medical attention.

When will I know the results of the Apgar test?

Your baby’s healthcare provider will perform the Apgar tests at one minute after your baby’s birth and at five minutes after their birth. They’ll be able to determine your baby’s Apgar scores at these times. If your baby’s healthcare provider has any concerns about your baby’s Apgar score, they’ll let you know what’s going on and what care they’re giving your baby.

Dr. Virginia Apgar developed the Apgar score in 1952. She came up with the scoring system as a standard method to quickly assess a newborn’s health immediately after birth. Dr. Apgar’s scoring system became the first clinical method to recognize the health needs of newborn babies. Her work also helped spur the development of specialized newborn intensive care. In 1963, the APGAR acronym was coined from Dr. Apgar’s name.

A note from Cleveland Clinic

After your baby is born, your baby’s healthcare providers will want to assess their health condition. The Apgar score is a simple and fast method to help them determine your baby’s health status. But don’t put too much focus on your baby’s Apgar score. Many newborns with low Apgar scores just need a little more time adjusting to life outside of your womb. Most babies go on to live normal, healthy lives.

Last reviewed by a Cleveland Clinic medical professional on 05/24/2022.

References

• American Academy of Pediatrics. Apgar Scores. (https://www.healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/Apgar-Scores.aspx) Accessed 5/24/2022.
• American College of Obstetricians and Gynecologists. The Apgar Score. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score) Accessed 5/24/2022.
• MedlinePlus. Apgar score. (https://medlineplus.gov/ency/article/003402.htm) Accessed 5/24/2022.

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The Apgar scoring system is divided into five categories. Each category receives a score of 0 to 2 points. At most, a child will receive an overall score of 10. However, a baby rarely scores a 10 in the first few moments of life. This is because most babies have blue hands or feet immediately after birth.

A: Activity/muscle tone

• 0 points: limp or floppy
• 1 point: limbs flexed
• 2 points: active movement

P: Pulse/heart rate

• 0 points: absent
• 1 point: less than 100 beats per minute
• 2 points: greater than 100 beats per minute

G: Grimace (response to stimulation, such as suctioning the baby’s nose)

• 0 points: absent
• 1 point: facial movement/grimace with stimulation
• 2 points: cough or sneeze, cry and withdrawal of foot with stimulation

A: Appearance (color)

• 0 points: blue, bluish-gray, or pale all over
• 1 point: body pink but extremities blue
• 2 points: pink all over

R: Respiration/breathing

• 0 points: absent
• 1 point: irregular, weak crying
• 2 points: good, strong cry

The Apgar scores are recorded at one and five minutes. This is because if a baby’s scores are low at one minute, a medical staff will likely intervene, or increased interventions already started.

At five minutes, the baby has ideally improved. If the score is very low after five minutes, the medical staff may reassess the score after 10 minutes. Doctors expect that some babies may have lower Apgar scores. These include:

• premature babies
• babies born via cesarean delivery
• babies who had complicated deliveries