The Apgar Score: Pediatrics
The Apgar Score: Pediatrics
The Apgar Score: Pediatrics
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POLICY STATEMENT
ABSTRACT
The Apgar score provides a convenient shorthand for reporting the status of the
newborn infant and the response to resuscitation. The Apgar score has been used
inappropriately to predict specific neurologic outcome in the term infant. There are
no consistent data on the significance of the Apgar score in preterm infants. The
Apgar score has limitations, and it is inappropriate to use it alone to establish the
diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equiv-
alent to a score assigned to a spontaneously breathing infant. An expanded Apgar
score reporting form will account for concurrent resuscitative interventions and
provide information to improve systems of perinatal and neonatal care.
INTRODUCTION
In 1952, Dr Virginia Apgar devised a scoring system that was a rapid method of
assessing the clinical status of the newborn infant at 1 minute of age and the need
for prompt intervention to establish breathing.1 A second report evaluating a larger
number of patients was published in 1958.2 This scoring system provided a
standardized assessment for infants after delivery. The Apgar score comprises 5
components: heart rate, respiratory effort, muscle tone, reflex irritability, and
color, each of which is given a score of 0, 1, or 2. The score is now reported at 1
and 5 minutes after birth. The Apgar score continues to provide a convenient
shorthand for reporting the status of the newborn infant and the response to
resuscitation. The Apgar score has been used inappropriately in term infants to
predict specific neurologic outcome. Because there are no consistent data on the www.pediatrics.org/cgi/doi/10.1542/
significance of the Apgar score in preterm infants, in this population the score peds.2006-0325
should not be used for any purpose other than ongoing assessment in the delivery doi:10.1542/peds.2006-0325
room. The purpose of this statement is to place the Apgar score in its proper All policy statements from the American
perspective. Academy of Pediatrics automatically
expire 5 years after publication unless
The neonatal resuscitation program (NRP) guidelines3 state that “Apgar scores reaffirmed, revised, or retired at or
should not be used to dictate appropriate resuscitative actions, nor should inter- before that time.
ventions for depressed infants be delayed until the 1-minute assessment.” How- Key Words
ever, an Apgar score that remains 0 beyond 10 minutes of age may be useful in Apgar score, asphyxia, neurologic
outcome, resuscitation, cerebral palsy
determining whether additional resuscitative efforts are indicated.4 The current
Abbreviation
NRP guidelines3 state that “if there is no heart rate after 10 minutes of complete NRP—neonatal resuscitation program
and adequate resuscitation efforts, and there is no evidence of other causes of PEDIATRICS (ISSN Numbers: Print, 0031-4005;
newborn compromise, discontinuation of resuscitation efforts may be appropriate. Online, 1098-4275). Copyright © 2006 by the
American Academy of Pediatrics and the
Current data indicate that, after 10 minutes of asystole, newborns are very un- American College of Obstetricians and
likely to survive, or the rare survivor is likely to survive with severe disability.” Gynecologists