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The Apgar score was devised in 1952 by Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth.
The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10.
The five criteria of the Apgar score
| | Score 0 | Score 1 | Score 2 | | Heart rate | absent | <100 | >100 | | Respiration | absent | weak or irregular | strong | | Muscle tone | none | some flexion | active movement | | Reflex irritability | no response
to stimulation | grimace/feeble cry
when stimulated | sneeze/cough/pulls away
when stimulated | | Skin color | blue all over | blue at extremities | normal |
The test is generally done at 1 and 5 minutes after birth, and may be repeated later if the score is, and remains, low. Scores below 3 are generally regarded as critically low, with 4 – 7 fairly low and over 7 generally normal.
Low scores at the one minute test may require medical attention, but are not an indication of longer term problems, particularly if there is an improvement by the stage of the five minute test. If the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer term neurological damage. There is also a small but significant increase in the risk of cerebral palsy. However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long–term predictions on a child's health.
Some ten years after the initial publication, the acronym APGAR was coined in the US as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. The mnemonic was introduced in 1963 by the pediatrician Dr. Joseph Butterfield. The acronym also exists in German (Atmung, Puls, Grundtonus, Aussehen, Reflexe) although here the letters have different meanings.
Another such backformation attempting to make Apgar an acronym is American Pediatric Gross Assessment Record. The test, however, is named for Dr. Apgar.
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