Dr Virginia Apgar was a remarkable physician who recognised the importance of having an easy, effective way of evaluating a newborn baby. In 1949, while discussing this topic with a student, she came up with five key points in recognising distress in a newborn infant. After some fine-tuning, she presented this score in 1952, which was subsequently published the next year. This score is the same one used today.

At the moment the baby is born, a timer is set which beeps at one and five minutes. When the timer goes off, the baby is evaluated and a score assigned. This score helps the nurse, physician, midwife or whoever is aiding the baby to evaluate whether the baby needs assistance in adapting to the outside world. Here are the parameters for assigning the Apgar scores:

Score	0	1	2
Heart Rate	Absent	<100/minute	>100/minute
Respirations (breathing)	Absent	Slow, irregular	Good, strong cry
Muscle Tone	Limp	Some flexing of arms and legs	Active motion
Color	Completely blue or pale	Body pink with hands/feet blue	Completely pink
Reflex	Absent	Grimace	Grimace and cough or sneeze

(The reflex score is based upon the reaction the baby has to pinching his or her nose.)

When the score at one minute is seven or lower, it implies that the baby may have experienced some difficulties during labour or the birthing process that lowered the oxygen content in the blood. Notice the emphasis on the word ‘may’. There are many babies with lower Apgar scores who have completely normal oxygen levels and for one reason or another simply get vigorous a little later.

A lot of myth and mystery surrounds what this score means. Parents get nervous that a low Apgar score means the baby will have significant problems either in the near future or later on in life. This is not the case, just as it is not true that having a high score eliminates the possibility of future difficulties. The score's only purpose is to alert the midwife to the fact that the baby may need assistance. It also allows the midwife to monitor the effectiveness of any interventions. If the score goes up, it implies the interventions are working.

A lot of research has been done on the Apgar score to see if it can be used to predict those who will have problems such as learning difficulties, cerebral palsy, seizures, etc. These studies have shown it to not be reliably predictive, proving that the score is great for what Dr Apgar originally intended it to be and nothing else: a quick, easy way of figuring out if a baby needs help.

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Apgar: What is it? What do scores mean?