The APGAR Scoring System

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The APGAR Scoring System was developed by Dr. Virginia APGAR as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.

Assess	0	1	2
HEART RATE	Absent	Below 100	Above 100
RESPIRATION	Absent	Slow	Good crying
MUSCLE TONE	Flaccid	Some flexion	Active motion
REFLEX IRRITABILITY	No Response	Grimace	Vigorous cry
COLOR	Blue all over	Body pink, extremities blue	Pink all over

SCORE:

• 7-10 Good adjustment, vigorous
• Moderately depressed infant, needs airway clearance
• Severely depressed infant, in need of resuscitation

Source: Outline in Obstetrics, 2004 Edition by Maria Loreto J. Evangelista-Sia

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