It is important to recognize the limitations of the Apgar score. The term asphyxia, which describes a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be documented on the basis of laboratory test results.
Asphyxia is defined as the marked impairment of gas exchange, which, if prolonged, leads to progressive hypoxemia, hypercapnia, and significant metabolic acidosis. Furthermore, although the score is widely used in outcome studies, its inappropriate use has led to an erroneous definition of asphyxia. 4 In that report, an Apgar score of 0 to 3 at 5 minutes or more was considered a nonspecific sign of illness, which “may be one of the first indications of encephalopathy.” However, a persistently low Apgar score alone is not a specific indicator for intrapartum compromise. The Neonatal Encephalopathy and Neurologic Outcome report defines a 5-minute Apgar score of 7 to 10 as reassuring, a score of 4 to 6 as moderately abnormal, and a score of 0 to 3 as low in the term infant and late-preterm infant. 3 The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if it is needed however, it has been inappropriately used to predict individual adverse neurologic outcome. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7. Thus, the Apgar score quantitates clinical signs of neonatal depression, such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations.
Each of these components is given a score of 0, 1, or 2. The Apgar score comprises 5 components: (1) color (2) heart rate (3) reflexes (4) muscle tone and (5) respiration. 2 This scoring system provided a standardized assessment for infants after delivery. 1 Dr Apgar subsequently published a second report that included a larger number of patients. In 1952, Dr Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing.
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