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What's an APGAR Test and Why is it Performed?

The APGAR test was developed in 1952 by Virginia Apgar, an American anesthesiologist, as a way to gauge the physical condition of babies immediately after birth, before they were taken to the nursery. It was common practice to whisk babies away to the nursery without a formal examination directly after birth, prior to Dr. Apgar's intervention.

An APGAR is the first test that a baby will take in his/her life. Immediately after birth, within 60 seconds, the APGAR test is given to assess how well baby has weathered birth, and if there are any physical conditions present requiring immediate medical treatment. There are five areas that are considered and each is given a score between 0-2, with 2 being the highest rating for a maximum score of 10. The five areas are: A is for Activity, meaning muscle tone, P is for Pulse to determine heart rate, G is for Grimace which is a reflex response, A is for Appearance or skin color, and R is for Respiration or breathing. The first APGAR test is performed at 60 seconds and the second at 5 minutes. The medical team assesses the baby's response according to the following scale:

Activity
     0 - Absent - no movement or limp
     1 - Little movement, some arms and legs flexion
     2 - Active movement

Pulse
     0 - Absent - no heart beat
     1 - Less than 100 bpm (beats per minute)
     2 - More than 100 bpm (beats per minute)

Grimace
     0 - Absent - no response
     1 - Facial movement during stimulation or suctioning
     2 - Facial movement with cough, sneeze or pulling away during stimulation or suctioning

Appearance
     0 - Absent - pale or bluish-gray in color
     1 - Body color good, but extremities (hands and feet) are bluish-gray
     2 - Good skin color overall

Respiration
     0 - Absent - not breathing
     1 - Slow or irregular breathing pattern, weak cries/whimper
     2 - Normal effort and breathing rate, strong cries

What does it all mean?

An APGAR score of 7 or better at one minute is very good and means that baby is generally healthy. Parents should relax if the score is not a 10. Most babies do not have great coloring immediately following birth, or may require a little suctioning of mucus to improve breathing.

An APGAR score of 4 to 6 at the one minute test means that baby requires some medical attention. This may mean suctioning and/or oxygen to help baby adjust to his new environment. It is not uncommon for babies to have APGAR scores within this range.

An APGAR score of 0-3 is serious and means resuscitation is required immediately. While a typical APGAR is performed at 60 seconds and again at 5 minutes; a baby with a 0-3 score and a difficult resuscitation, may require tests at 1 minute, 5 minutes and again at 5 minute intervals.

Parents should also note that lower APGAR scores are typically found in infants born by c-sections, as a result of high-risk pregnancies, complicated labor/deliveries, or premature deliveries.

A low APGAR score at birth is not necessarily a predecessor for physical development, intelligence, or mental behavior problems. APGAR testing was developed as a tool to provide babies with an immediate assessment, so any necessary medical intervention could be secured as soon as possible. It's simply one of many tools medical professionals will use over the years to assess a child's health.

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