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The importance of Apgar scores

Аuthor: Аldanova Aziza

Editor: Аibulova Diana







      When a newborn baby is born, parents are necessarily informed about basic parameters such as weight and height, but there is also a third tool, the Apgar Scale. This scale was proposed by the American anesthesiologist Virginia Apgar at the 27th Annual Congress of Anesthesiologists in 1952 to quickly assess the health of the newborn. Physicians and midwives measure five parameters in the baby: cardiac activity, respiration, muscle tone, reflex excitability, and skin color, and give a score from 0 to 2 for each parameter. Thus, the total score ranges from 0 to 10; the higher the score on the scale, the better the health, increasing the likelihood of survival and determining the need for resuscitation procedures. Most physicians and obstetricians believe that the Apgar Scale is the most accessible and quickest tool for assessing the condition of a newborn in the delivery room. And they note the importance of recording scores and values at the 1st, 5th, and 10th minute after birth to calculate the risk of neonatal death and the development of epilepsy and cerebral palsy (CP).


      However, some have questioned the value of Apgar scores in premature infants because the immaturity of these infants may result in lower scores than those of babies born at term. This has prompted researchers to investigate the use of the Apgar Scale to assess and predict the risk of mortality in preterm infants during the first four weeks of life. The study, conducted by Swedish scientists at Karolinska Institutet, examined data on babies born after 22 to 36 weeks of gestation from 1992 to 2016, calculating Apgar scores at 5 and 10 minutes after birth. As expected, the neonatal mortality rate increases sharply with shorter gestational ages to 76.5% for babies born at 22 weeks and to 0.2% for babies born at later gestational ages. Regardless of gestational age, the risk of neonatal mortality was increased by a lower Apgar score. And even a slight increase in the Apgar score from five to ten minutes after birth reduces the risk of neonatal mortality.


       It is well known that a low Apgar score between a score of 0 and 6 one or five minutes after birth is associated with a greater risk of cerebral palsy and epilepsy. Researchers were able to confirm a linear correlation between score changes and the risk of developing neurological disease. Data from more than 1.2 million children without malformations and born at full term between 1999 and 2012 were taken for the study. Of these, children under 16 diagnosed with cerebral palsy and epilepsy were identified, then the risk was calculated for each Apgar scale calculation after the 1st, 5th and 10th minutes. And what a surprise the researchers had when they saw the results. A total of 1,221 children were diagnosed with cerebral palsy and the risk gradually increased with decreasing scores at five minutes. Compared to babies who scored 10 on the Apgar scale, babies who scored 9 had twice the risk of developing cerebral palsy. And 3,927 babies were diagnosed with epilepsy, and the risk of epilepsy did not increase as markedly as babies with cerebral palsy. The study, also proved that small changes in scores from five to ten minutes can affect the risks.      


      Unfortunately, experts are still unable to pinpoint the reasons for the lower Apgar scores, but they urge that this score be recognized as the best and most accessible tool for assessing newborn health. Because of these findings, researchers note the importance of recording Apgar scores after one minute, five minutes, and 10 minutes for early diagnosis of congenital abnormalities and reducing the risk of neonatal mortality. Also, the more babies with low scores received full clinical attention, regardless of gestational age, and the better the stabilization of circulation and respiration immediately after birth, the greater the likelihood of survival.