APGAR Assessment Study Guide

Study Guides

Introduction:

An APGAR assessment is a quick evaluation of a newborn’s physical condition. It is typically done at 1 minute and 5 minutes after birth and can be repeated as needed. The assessment is named after Dr. Virginia Apgar, who developed it in the 1950s. Dr. Virginia Apgar was also the first woman to become a full-time professor at Columbia University College of Physicians and Surgeons.

The APGAR assessment consists of five categories, each rated on a scale of 0 to 2 points. The categories are:

Appearance

This refers to the baby’s skin color.

A score of 0 means the baby is blue or pale all over
A score of 1 means the baby is pink but only on the extremities (arms and legs)
A score of 2 means the baby is pink all over.

Pulse

This refers to the baby’s heart rate.

A score of 0 means no pulse is present
A score of 1 means a pulse of less than 100 beats per minute
A score of 2 means a pulse of 100 or more beats per minute.

Grimace

This refers to the baby’s reflexes.

A score of 0 means the baby does not react to stimulation
A score of 1 means the baby responds with grimacing or weak movements
A score of 2 means the baby responds with strong movements or crying

Activity

This refers to the baby’s muscle tone.

A score of 0 means the baby is limp and flaccid
A score of 1 means the baby has some flexion of the arms and legs
A score of 2 means the baby has active motion and good muscle tone

Respiration

This refers to the baby’s breathing

A score of 0 means the baby is not breathing
a score of 1 means the baby is breathing irregularly or weakly
a score of 2 means the baby is breathing regularly and strongly.

What The Scores Mean

The scores for each category are added to give a total score ranging from 0 to 10. A score of 7 or above is generally considered normal. In contrast, a score below 7 may indicate that the baby needs medical intervention.

NRP Guidelines

Begin the assessment within 1 minute of birth.
Check the baby’s appearance by evaluating the skin color. Be sure to give it a score of 0, 1, or 2.
Check the baby’s pulse. You can feel a pulse on the inside of the upper arm or the chest below the collarbone. Be sure to give it a score of 0, 1, or 2.
Check the baby’s reflexes by gently stimulating the soles of the feet or tapping the soles lightly. Be sure to give it a score of 0, 1, or 2.
Check the baby’s muscle tone by gently moving the arms and legs. Be sure to give it a score of 0, 1, or 2.
Check the baby’s respirations by listening for breathing and counting the number of breaths in a minute. Be sure to give it a score of 0, 1, or 2.
Add up the scores for each category to determine the baby’s total APGAR score. A score of 7 or above is generally considered normal. In contrast, a score below 7 may indicate that the baby needs medical intervention.
If the baby’s APGAR score is less than 7, begin resuscitation efforts according to NRP guidelines, which may include ventilation with a bag and mask, chest compressions, and medications.
Repeat the APGAR assessment 5 minutes after birth (4 minutes after the first assessment) to assess the effectiveness of resuscitation efforts and determine if further intervention is needed. Depending on the resource you look at, if the 5 minute APGAR is less than 7, you should repeat the assessment every 5 minutes (at 10, 15, and 20 minutes post-birth) and continue to support the newborn.

Closing

It is not easy to perform a proper APGAR assessment in the back of the ambulance or in someones home, especially in a resource limited environment. However, if you keep these tools in mind it is possible to plan and make sure you get a good score, and you will continue to allow yourself to give good patient care. You will only get better with practice, so don’t be afraid to create scenarios to come up with various scores!

Scenarios

Practice 1

For example: You deliver a newborn who 5 minutes after birth is breathing fast, has a pulse of 110, has a strong cry, weakly resists your movements to flex and extend their legs, and has a pink core with blue extremities. What would this newborns 5 minutes APGAR score be?

If you chose the answer 8 then you would be correct.

A- 1 (acrocyanosis)

P-2 (HR over 100)

G-2 (strong cry)

A-1 (weak resistance)

R-2 (fast breathing, and strong cry)

Tips and Tricks

Make sure you have a clean, dry surface to work on and a warm blanket or pad to wrap the baby in.
Gently stimulate the baby by rubbing the soles of the feet or tapping the soles lightly.
Use a flashlight to check the baby’s skin color. (Don’t let it be too bright!)
Feel for the baby’s pulse by placing two fingers on the inside of the upper arm or the chest just below the collarbone (The newborns are squishy still so, you can feel the arteries/heartbeat under the
Observe the baby’s reflexes and muscle tone by gently moving the arms and legs. Feel for resistance as you try to flex or extend the arms or legs
Listen for the baby’s breathing and count the number of breaths in a minute. Because newborns can have irregular breathings patterns, it is best practice to count for a full minute instead of multiply

If you’re interested in additional resources, we have a brief study guide for all the main systems available for free, with even more available if you subscribe and create a paid account today.