The Apgar Score

The Apgar score is widely used as a part of the early assessment of the newborn (Table 22-1). A score of 0, 1, or 2 is assigned to each of the five physical signs at 1 and 5 minutes after birth. The Apgar score should not be used as a substitute for assessing the ABCs in neonatal resuscitation, and resuscitation efforts should not be delayed or interrupted to assign an Apgar score. However, the Apgar score does allow a quick and consistent way for different providers to describe an infant's condition. A score of 7 to 10 is considered normal. If the 5-minute Apgar score is abnormal, less than 7, appropriate resuscitation measures should be continued and Apgar scores assigned every 5 minutes until the infant is stabilized.

Although the Apgar score provides a systematic way for different providers to describe an infant's condition in the first minutes of life, it correlates poorly with future neurologic outcomes (AAP and ACOG, 1996). A poor Apgar score alone cannot be used to diagnose asphyxia in the newborn or predict the development of cerebral palsy. However, the Apgar score is correlated with early infant death. In a large population study of term infants, an abnormal 5-minute Apgar score correlated with a significantly increased risk of death in the first 28 days of life. Even in infants with the lowest scores, however, death within 28 days is uncommon, occurring in 244 of 1000 infants with 5-minute Apgar scores of 0 to 3 (Casey et al., 2001).

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