APGAR Scoring

➢ is a quick, effective assessment of a newborn's physical condition after birth.

➢ Developed by Dr. Virginia Apgar, it evaluates five criteria:
1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration.

Each criterion is rated on a scale of 0 to 2, with a maximum total score of 10. This scoring is typically
conducted at 1 minute and 5 minutes post-birth, and if the score remains low, additional assessments may
be performed at 10 and 20 minutes.

Dr. Virginia Apgar

➢ was an American obstetrical anesthesiologist and pioneering medical researcher.
➢ Born in 1909
➢ created the APGAR score in 1952 to give a fast, standardized assessment of a newborn's health
right after birth.
o This scoring system transformed neonatal care by providing a simple, effective way to
identify infants that require immediate medical intervention.
o Apgar's work had a significant impact on obstetrics and neonatology, helping to increase
newborn survival rates.
o Her legacy lives on as the APGAR score are widely used globally.

Here’s a breakdown based on the latest guidelines from Pillitteri’s "Maternal and Child Health Nursing:
Care of the Childbearing & Childrearing Family":

APGAR scoring table - discussions, rationales, and nursing responsibilities:

APGAR
Score 0 Score 1 Score 2 Discussion & Rationale
Criteria

Skin color reflects oxygenation and

Pale or Pink body, blue circulation. A fully pink appearance
Appearance
cyanotic all extremities Entirely pink indicates adequate oxygenation.
(Skin Color)
over (acrocyanosis) Cyanosis may suggest respiratory or
circulatory issues.

Heart rate is a critical indicator of

cardiovascular health. A rate < 100
Pulse (Heart
Absent < 100 bpm ≥ 100 bpm bpm may indicate bradycardia,
Rate)
which can lead to hypoxia and
requires immediate intervention.
APGAR
Score 0 Score 1 Score 2 Discussion & Rationale
Criteria

Reflex irritability tests neurological

Grimace No response Grimace or weak Vigorous cry,
response. A strong cry or withdrawal
(Reflex to response to cough, or sneeze
response indicates intact nervous
Irritability) stimulation stimulation with stimulation
system reflexes and function.

Muscle tone indicates neurological

Active motion, status. Active movement shows good
Activity Limp or Some flexion of
well-flexed neurological health, while limpness
(Muscle Tone) flaccid extremities
extremities suggests possible neurologic
depression.

Respiratory effort is essential for

Respiration Slow or irregular Good, strong oxygenation. A strong cry suggests
Not
(Breathing breathing, weak cry with regular effective lung function, while weak
breathing
Effort) cry breathing or absent respirations indicate
respiratory distress.

APGAR Score Interpretation

Total
Interpretation Action
Score

7-10 Normal; newborn in good health Routine care; observe for any minor issues

Moderate distress: some

Provide oxygen, stimulate the newborn as needed, and
4-6 resuscitative measures may be
monitor closely
required

Initiate advanced neonatal resuscitation (airway clearing,

Severe distress: immediate
0-3 positive pressure ventilation, chest compressions if
intervention is required
necessary)

Nursing Responsibilities

Responsibility Details Rationale

Ensure resuscitation equipment is Being prepared allows quick response

Preparation for
ready and understand APGAR criteria to complications, promoting positive
Assessment
thoroughly. outcomes.
Responsibility Details Rationale

Performing APGAR Objective scoring reflects newborn

Score newborn objectively, recording
Scoring at 1 and 5 adaptation accurately, guiding
each category separately.
Minutes appropriate care.

If score < 7 at 5 minutes, reassess

Monitoring progression informs
Reassessment and every 5 minutes up to 20 minutes,
healthcare decisions and supports care
Documentation documenting findings and
planning.
interventions.

For scores 0-3, initiate advanced Immediate intervention is crucial to

Intervention for Low neonatal resuscitation (e.g., airway avoid hypoxia and potential
Scores clearing, positive pressure complications associated with low
ventilation). APGAR scores.

Report findings and concerns to Clear communication ensures timely

Communication with
healthcare providers and update medical intervention and emotional
Team & Family
family compassionately. support for the family.

Ongoing monitoring and warmth help

Post-Assessment Continue monitoring for distress and
maintain the newborn’s stability and
Support & Monitoring maintain a warm, stable environment.
thermoregulation.

Reference:
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing & Childrearing Family
(Latest Edition).