Introduction

Your baby's first exam in life that she needs to pass with flying colours is the Apgar Test. Developed by Virginia Apgar, an anesthesiologist, it is performed one minute after birth and then repeated after five minutes. Dr. Apgar has identified certain critical signs that are measured and rated immediately after birth. The results reflect the baby's general condition and help the doctors to determine the nature of the baby's post-delivery care.
 

The rating scale

The baby is rated on a scale of zero to two on the following five signs:

• Appearance or colour
• Pulse or heart rate
• Grimace or reflex irritability
• Activity or muscle tone
• Respiration

The babies are rated in the following manner:

Appearance: If the baby is pink all over, she will get the maximum score of 2. If the body is pink with the exception of the arms and legs, which are blue, the baby will score 1. She will get a minimum score of 0, if her body is blue all over.

Pulse: The baby scores 2 if her pulse rate is above 100 beats a minute. If her pulse rate is below 100, she will score 1 and if it not detectable, she will score 0.

Reflex irritability: The doctor will slap the baby on the soles of her feet. If she cries lustily in response, she will score 2. A grimace or slight cry will get her a score of 1. If she does not respond at all, she will score 0. 

Activity: A baby that flails its arms and legs or otherwise displays a lot of activity at birth scores a two in this category. If the baby moves her limbs slightly, she will receive a score of 1. If the baby is limp and flaccid, and shows no activity, she will score 0.

Breathing: Strong efforts to breathe, accompanied by crying are a sign that the baby's lungs are in good working order. She will receive a score of 2. Slow, irregular breathing rates a 1. No respiration gets the lowest score of 0.
 

What the scores mean

The baby's scores in these five categories are added up to give the Apgar score. (The maximum score is 10). It has been observed that most babies score between 7 and 10 points one minute after birth, indicating that the baby is generally in good health and will require only routine post-deliver care. Babies who score between 4 and 6 are in fair condition, though they may require help to breathe. They may be put on oxygen or if there is mucus in the throat it will have to be removed to prevent any obstruction in the baby breathing. Those babies that have a total score below 4 are normally pale, limp and unresponsive. They will require immediate life-saving efforts. The baby's lungs will have to be externally inflated and the throat will have to be suctioned to clear the air passage. Such babies will have to be closely monitored in the intensive care until their bodies take over and they can wing it on their own.
 

The five minute score

The Apgar test is repeated after five minutes. While the one-minute score is an indication to doctors as to the nature of the immediate care required post-delivery, the five minute score was thought to be a good predictor of the baby's survival and development in early infancy.