With the purpose to verify the health status of your newborn, the Apgar test was created by Virginia Apgar, an American anesthetist, in 1952. It analyzes whether or not the newborn has adjusted to life outside the womb, if they can adapt well to the new world or if they need help. Especially because the baby was taken from a place where they received everything they needed and didn’t even breathe, to a new environment where they need to do that all on their own. The Apgar test rapidly gained worldwide acceptance as it is easily applied and very reliable in identifying the first necessary baby care.

What is the evaluation criteria for the Apgar test?

It is done in the first and fifth minutes of the baby’s life; the Apgar test is recorded and each criterion receives scores from 0 to 2, reaching a total of 10 points. The test has five assessment ratings:

  1. The heart rate that is checked by the beat per minute;
  2. Breathing that is assessed according to the baby cry – weak or intense;
  3. The muscle tone is analyzed by the flexibility and movement of the legs;
  4. Reflexes are identified by grimacing, coughing, or sneezing as a reaction to a specific stimulus.
  5. The skin color, that can be pale, bluish or pink.

The first-minute test serves to assess how the intrauterine transition was out of the mother’s belly whereas the fifth-minute assessment more accurately checks the baby’s condition, which is usually more stable by this second test. The first minute test may not be accurate, the baby may gag, or choke since it is the first time they’re breathing on their own when they are tired with all the work they had to do through labor and all of this affects the test results.

How is the evaluation done?

It is common that in the first test the grade is up to two points lower than the grade of the second test. If in the second test, when the baby completes five minutes outside the womb, they obtains an Apgar score that is less than seven, the specialists continue to do them every five minutes until the newborn is twenty minutes old.

The fact that the baby hasn’t received a high grade doesn’t mean that they will have a problem or compromise in their development or that they will take longer to reach milestones and develop skills. In many cases, the newborn only needs help to adapt to the new environment. It is very important to point out that the pediatrician who will be accompanying your baby must have access to the Apgar test scores to understand their entire history.

How are grades given?

If the baby has a purple or dark appearance to their skin, they will receive a score of 0 for the skin color criterion. If only the hands and feet are purple, the score will be 1 and if they have   normal skin color, they will receive a score of 2. In the other criterion, the process is the same, if the baby has difficulty breathing, they will receive a score of 0, if breathing isn’t ideal, then they will receive a score of 1 and if the baby is born crying intensely, they will receive a score of 2.

What is the ideal Apgar score?

Babies who receive the Apgar Score between 8 and 10 are healthy, have adapted well to the environment, and haven’t suffered suffocation. Those who scored between 6 and 7, face slight breathing difficulties or transient asphyxia. Babies who received between 3 and 5 in the evaluation present moderate asphyxia and grades from 0 to 3 are severe cases.

According to pediatrician’s diagnosis, the necessary actions will be taken according to the baby’s grades. For example, if the baby received a score of 5 on the first test, they may have had airway aspiration and will therefore receive oxygen. Those suffering from moderate or severe asphyxia, will need greater support.

The Apgar test and the health of the baby in the future

In addition to its importance for the initiation of baby care, the Apgar test is a prognosis of the baby’s health, as it determines whether the baby needs specific care or not, if, for example, they have any heart disease or lung disorder.

There are cases in which, even if the baby didn’t receive good grades, nothing was found in clinical evaluations, so, parents don’t have to worry much about the results of the tests. As long as they are on top of their follow-up visits with the medical specialists in the first months of the baby’s life.

A study by the journal JAMA Pediatrics, states that mothers of newborns who scored low on the Apgar test are nine times more likely to be admitted to the ICU. According to the study, pregnancy is a two-way street and everything the baby receives from the mother is taken to life outside the womb. In cases of high-risk pregnancies, in which the mother has diabetes, hypertension, or some chronic disease, this is likely to affect the fetus and the baby to have a more challenging start in life.