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Apgar Scoring System

The APGAR scoring system is used universally in the delivery room to assess the overall health and integrity of the newborn immediately after birth. A score of zero to two is assigned in each of the five areas at one and five minutes after birth. If prolonged resuscitation is needed, scoring continues at five minute intervals until the infant is stabilized. The five areas are: Activity—from no movement (0) to tone, movement, and flexion (2); Pulse—from absent (0) to more than one hundred beats per minute (2); Grimace—from no reflex irritability (0) to cough or pulling away (2); Appearance—from blue-gray color (0) to normal (2); and Respiration—from absent (0) to regular with crying (2). A score of seven to ten is normal. A score of four to seven signals a need for resuscitation. And a score of three or below signals the need for intense, and sometimes prolonged, resuscitation. A low score (less than three) of long duration (greater than ten minutes) may correlate with future neurological dys-function.


Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Policy Statement. "Use and Abuse of the APGAR Score."Pediatrics 98, no. 1 (1996):141-142.

Freeman, John, and Karin Nelson. "Intrapartum Asphyxia and Cerebral Palsy." Pediatrics 82, no. 2 (1988):240-249.

Goodwin, T. Murphy. "Role of the APGAR Score in Assessing Perinatal Asphyxia." Contemporary OB/GYN (June 1997):80-92.

Nelson, Karin, and Jonas Ellenberg. "Obstetric Complications asRisk Factors for Cerebral or Seizure Disorders." Journal of the American Medical Association (1984):251, 1843-1848.

Socol, Michael, Patricia Garcia, and Susan Riter. "DepressedAPGAR Scores, Acid-Base Status, and Neurologic Outcome." American Journal of Obstetrics and Gynecology 170, no. 4 (1994):991-999.

Joanne Bregman

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