What is the Apgar Test

Testing a baby's physical health is an essential step after birth. The Apgar test is the gold standard for newborn testing. By examining various factors — like reflexes, heart rate, and appearance — this assessment helps health care providers determine if a baby needs medical intervention or assistance.

Read on to learn more about the Apgar test, the criteria it measures, and what different scores indicate.

The Apgar test is an assessment to evaluate the physical condition of babies immediately after birth. It was developed by Dr. Virginia Apgar in 1952 and determines if a baby has heart or breathing complications and requires resuscitation.

Dr. Apgar's test became the first clinical method to identify newborns' health needs. It also helped spark the development of neonatal intensive care units (NICUs). You can remember the tenets of the Apgar test using it as an acronym:

• Appearance
• Pulse
• Grimace
• Activity
• Respiration

A pediatrician, nurse, OB-GYN, or midwife performs this test at the one- and five-minute mark after a baby's birth — unless emergency circumstances require the baby to be transferred to the NICU right away.

The one-minute score measures how well the newborn tolerated the labor and delivery process. The five-minute score determines how well the baby is acclimating to life outside their mother's womb.

In some cases, an infant with a low score at five minutes may be tested again at the 10-minute mark. Typically, this occurs for newborns with a score less than 5. This retesting period allows the child time to recover from birth. The Apgar test can also measure how well a baby responds to resuscitation if it is necessary after birth.

A newborn is assigned an Apgar score of 0-2 on these five metrics.

The doctor will check how well the newborn is breathing:

• Good breathing and crying: 2 points
• Irregular or slow breathing: 1 point
• No breathing: 0 points

A health care provider will use a stethoscope to listen to the newborn's heart:

• Heartbeat of 100 beats per minute or greater: 2 points
• Heartbeat less than 100 beats per minute: 1 point
• Nondetectable heartbeat: 0 points

The doctor will measure your baby's movement and activity:

• Lots of moving around: 2 points
• Some arm and leg movement: 1 point
• Inactive, loose, or floppy muscles: 0 points

The health care provider will measure your baby's grimace response or reflex irritability. This is their response to stimulation, such as a mild pinch:

• Grimacing with a hearty cry, sneeze, or cough: 2 points
• Grimacing: 1 point
• Unresponsive to stimulation: 0 points

The doctor will examine your baby's skin color to determine their health:

• Pink all over: 2 points
• Pink body with blue extremities: 1 point
• Pale blue: 0 points

A baby can earn a total of 10 possible points. Essentially, the higher the score, the better the infant is adjusting to life outside the womb.

Most newborns receive a 7, 8, or 9 on the Apgar test. A perfect score is highly unusual, as most newborns lose a point for blue hands and feet. Blue extremities are a normal occurrence after birth due to underdeveloped blood circulation. In fact, a baby's hands and feet may remain bluish for several days.

An Apgar score of 7 or higher typically indicates a healthy newborn. The lower the score, the more help an infant needs adjusting to life outside their mother's womb. Here are the Apgar score ranges and what they usually indicate:

• A score of 7-10: The baby is in good to excellent health, only requiring routine post-delivery care.
• A score of 4-6: The baby is in fair condition. They may need some resuscitation.
• A score below 4: The baby needs immediate medical attention.

If a baby's Apgar score is below 7 at the five-minute mark, the doctor may repeat the test a few minutes later. This allows them to check the progress of any actions taken to address cardiac or respiratory concerns.

A low Apgar test score often results from the following factors:

• A cesarean section (C-section)
• Fluid in the baby's airway
• A premature birth
• A high-risk pregnancy
• A complicated labor and delivery process

If a baby scores low on their Apgar test, they may have trouble adjusting to life outside the womb due to an airway blockage, a traumatic birth, or other factors.

Keep in mind that a low Apgar score doesn't mean your baby is unhealthy or will have long-term health issues. It just means they need some form of medical care. If your doctor, nurse, or midwife has concerns about your newborn's score, they'll explain what the problem may be and the steps being taken to address it. Depending on the situation, the baby may require:

• Airway clearing: A newborn may require airway suctioning to stimulate their breathing.
• Oxygen: A doctor may place an oxygen mask over the baby's face to help them breathe properly. If the newborn doesn't start breathing independently within a few minutes, the doctor may place a tube in their windpipe.
• Medication or fluid: A newborn may receive medications and fluids through a blood vessel in their umbilical cord. This can help strengthen the baby's heartbeat.
• Physical stimulation: The doctor may stimulate and dry the newborn to help their heartbeat reach a normal rate.

Healthy babies sometimes score low in the first few minutes after birth. Additionally, most babies with low one-minute scores show healthy scores by the five-minute mark. If a baby still shows a low score after the above methods, they'll be moved to the NICU for more intensive treatment.

Just remember that an Apgar score isn't meant to reflect a baby's long-term health, behavior, personality, or intelligence. Most babies with low scores end up adjusting to life outside the womb just fine.

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