Under the Hood

Your Newborn's APGAR Score: What Does It Mean And When Should You Begin To Worry?

newborn baby
The APGAR test is a vital check-up for newborn babies to assess health and well-being based on Appearance, Pulse, Grimace, Activity, and Respiration. Reuters

Exactly one minute after you were born, you passed an important test, undoubtedly the most important in your life. At five minutes, you were once again given (and you once again passed) the very same examination. What is this exam? The APGAR test. The vital check-up was developed in 1952 by Dr. Virginia Apgar, an anesthesiologist, but most people prefer to think of it as acronym for Appearance, Pulse, Grimace, Activity, and Respiration.

At one-minute, a baby’s APGAR score indicates to a doctor (or midwife) how well the baby tolerated the process of birth. At five minutes, the second score demonstrates how well the baby is doing in the world outside the mother’s womb. For babies who do not sail through these first two tests, additional tests may be given after that. The test works in this way: Each of the five characteristics are scored on a scale of 0 to 2, with the high score indicating optimal health.

  1. Appearance (skin color should be normal not blue)
  2. Pulse (heart rate should be more than 100 beats per minute)
  3. Grimace response (reflexive response to stimulation should be a vigorous cry or withdrawal)
  4. Activity (baby should be moving around, not limp)
  5. Respiration (strong cries indicate health, irregular breathing is a problem)

Babies who score eight or more on the test are considered healthy and fit. While a high APGAR score is wonderful news to any parent, it does not predict the future intelligence or even future health of a baby. And, no matter how well a baby does, the test is re-calculated at five minutes to ensure the child is continuing along a healthy path, or, in the case of a low score, to see if the baby has begun to improve. Generally, a score lower than eight indicates a need for immediate attention, such as suctioning a baby’s airways to help with breathing.

Sometimes, though, a low score means more than just a temporary problem.

What A Low Score Could Mean

Past studies, for instance, have linked a very low five-minute APGAR score for a full-term baby to a slight increase in the risk of cerebral palsy. However, the overwhelming majority of infants with low five-minute scores do not develop this neurological disorder, which affects muscle coordination and control.

One recent scientific investigation tied low APGAR scores to risk factors for childhood autism and other pervasive developmental disorders (PDD), though, oddly, not Asperger syndrome. The study, conducted by researchers at Turku University Hospital in Finland, looked at past records of all single births throughout that country between 1990 and 2005. Then, they identified cases of childhood autism, Asperger syndrome, or PDD from the Finnish Hospital Discharge Register. After matching each of these 4,713 cases of autism and other disorders to four controls based on date of birth, sex, and place of birth, the researchers then analyzed all the obstetric information from the Finnish Medical Birth Register. The team of scientists discovered childhood autism and PDD could be linked to one-minute APGAR scores lower than seven.

Sad news though this may be, another recent study offers great hope to parents. The scientists in this investigation followed up on children six to seven years after experiencing perinatal hypoxic-ischaemic encephalopathy, which required a 10-minute APGAR score. What happened to these children and could their 10-minute scores predict a particular outcome? Among the 174 children studied, 75 percent of those with a 10-minute APGAR score of three or lower died or had a disability compared with 45 percent of those with scores greater than three. Each point increase in the 10-minute APGAR scores was linked to a significantly lower risk of death, or, disability and/or low IQ among survivors.

Surprisingly, a fifth of the infants with 10-minute APGAR scores of 0 survived to school age without disability: their IQ scores ranged between 77 and 99 (where 100 is considered average), while their attention and executive function abilities were normal.

Although this study is very small in scope, the researchers conclude by “suggesting the need for caution in limiting resuscitation to a specified duration.” APGAR scores clearly have diagnostic value and the potential to help doctors identify which newborn babies need a little help in adjusting to life outside the womb, still, for quite a few babies, low points on this particular scorecard are simply meaningless.

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