How Your Baby Is Evaluated

It’s easy to tell that a newborn who has a loud and lusty cry, vigorously moves his or her arms and legs, and protests mightily when disturbed has made an excellent transition to the outside world. Conversely, no special medical training is needed to understand that a newborn who makes no attempt to breathe, is listless and does not react to stimulation, requires immediate medical attention to assist in adjusting to the environment outside of the womb. However, between these two extremes, there is a broad spectrum of possible responses that a newborn can exhibit, and a precise way of evaluating the infant's critical physiological adjustment process was clearly needed.

In 1952, Dr. Virginia Apgar, an anesthesiologist, met that need by developing a system to evaluate newborn response within the first five minutes after birth. Five different characteristics are observed and scored. The total number of points is referred to as the Apgar score. More than 40 years after it was introduced, this scoring system remains a vital tool in assessing the newborn infant.

It is very important to keep in mind that Apgar scores are not measures of intelligence or brain function. They are merely a shorthand way of conveying information about the newborn's initial adjustment to the outside world. Apgar scores have virtually no prognostic significance. This means that they cannot predict an infant's future health, intelligence, or anything else.

The Apgar scoring system evaluates five different characteristics of the newborn: heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each characteristic can be rated from 0 to 2, with 0 as the worst score and 2 as the best. The total number of points is the Apgar score itself. The highest possible score is 10, although even the healthiest newborns are rarely rated 10. Usually, that's because of the color score. It can take many hours for a newborn to become a healthy color all the way down to the fingertips and toes.

The Apgar score is calculated twice: first at 1 minute and then at 5 minutes. The 1-minute Apgar score indicates whether a newborn requires help in making the all-important transition to breathing on its own. If a newborn has a low 1-minute Apgar score, he or she will probably receive assistance such as stimulation by rubbing with a warm blanket (the slap on the bottom is found only in old movies), supplemental oxygen, and suctioning of the mouth and nose to remove residual amniotic fluid. If the infant does not respond to these measures, a pediatrician may pass a tiny breathing tube into the baby's lungs to pump oxygen in and out of the lungs until the baby can breathe independently.

Most infants respond promptly to such assistance. The 5-minute Apgar score reflects the baby's response to these measures. By 5 minutes after birth, most babies, even those with low 1-minute Apgar scores, will have a score of 8 or 9. At 5 minutes, if the baby still has a score that is lower than 7, further assistance will be necessary.

It can be extremely frightening to watch nurses and doctors working over your new baby, coaxing him or her to take those first few breaths. In this situation, 5 minutes can feel like 5 hours. Yet when you consider the miraculous transition that birth requires, it is not surprising that many babies need a little help at first. It helps you to know that within the first 5 minutes almost all babies begin to breathe on their own. You will be happy and relieved when you hear those angry cries, signaling to all present, "Leave me alone; I can do it by myself!"