APGAR SCORES

As soon as your baby is born, a delivery nurse will set one timer for one minute and another for five minutes. When each of these time periods is up, a nurse or physician will give your baby her first "tests" called Apgars.

This scoring system (named after its creator, Virginia Apgar) helps the physician estimate your baby's general condition at birth. The test measures your baby's heart rate, breathing, muscle tone, reflex response and color. It cannot predict how healthy she will be as she grows up or how she will develop; nor does it indicate how bright she is or what her personality is like. But it does alert the hospital staff if she is sleepier or slower to respond than normal and may be in need of assistance as she adapts to her new world outside the womb.

What Apgar Scores Mean

Each characteristic is given an individual score; then all scores are totaled. For example, let's say your baby has a heart rate of more than 100, cries lustily, moves actively, grimaces and coughs in response to the syringe, but is blue; her one-minute Apgar score would be 8. About nine out of ten newborns in this country score in the 8 to 10 range. Because their hands and feet remain blue until they are quite warm, few score a perfect 10.

If your baby's Apgar scores are between 5 and 7 at one minute, she may have experienced some problems during birth that lowered the oxygen in her blood. In this case, the staff will probably dry her vigorously with a towel while oxygen is held under her nose. This should start her breathing deeply and improve her oxygen supply so that her five-minute Apgar scores total between 8 and 10.

A small percentage of newborns have Apgar scores of less than 5. For example, babies born prematurely or delivered by emergency C-section are more likely to have low scores than infants with normal births. These scores may reflect difficulties the baby experienced during labor, or problems with her heart or respiratory system.

Apgar Scoring System

Score	0	1	2
Heart Rate	Absent	Less than 100 beats per minute	More than 100 beats per minute
Respiration	Absent	Slow, irregular; weak cry	Good; strong cry
Muscle Tone	Limp	Some flexing of arms and legs	Active motion
Reflex*	Absent	Grimace	Grimace and cough or sneeze
Color	Blue or pale	Body pink; hands and feet blue	Completely pink

*Reflex judged by placing a catheter or bulb syringe in the infant's nose and watching her response.

If your baby's Apgar scores are very low, a mask may be placed over her face to pump oxygen directly into her lungs. If she's not breathing on her own within a few minutes, a tube can be placed into her windpipe, and fluids and medications may be administered through one of the blood vessels in her umbilical cord to strengthen her heartbeat. If her Apgar scores are still low after these treatments, she will be taken to the special-care nursery for more intensive medical attention.

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