How to Use the Apgar Score to Perform the Initial Assessment of a Neonate Immediately After Birth.

The Apgar score is a rapid assessment of the newborn's transition to the extrauterine existence based on five signs that indicate the physiologic state of the neonate: (1) heart rate, based on auscultation (listening) with a stethoscope; (2) respiratory effort, based on observed movement of the chest wall; (3) muscle tone, based on the degree of flexion and movement of the extremities; (4) reflex irritability, based on response to suctioning of the nares or pharynx; and generalized skin color, described as pallid, cyanotic, or pink. Evaluations are made 1 and 5 minutes after birth, usually by a nurse. The score of each category are added together to determine how the newborn is adjusting. Scores of 0 to 3 indicate severe distress, scores of 4 to 6 indicate moderate difficulty, and scores of 7 to 10 indicate that the infant is having minimal or no difficulty adjusting to extrauterine life.

These instructions are good for nurses/nursing students who will be performing these types of assessments on newborns. They can also be read by parents of newborns to understand the reason for and the process of this assessment.

What you need: Stethoscope and a watch/clock, suction equipment (bulb syringe)

Step 1: Assess Neonate's Heart Rate. 1 Minute & 5 Minutes After Birth.

Listen to the infant's heartrate for 1 full minute using a stethoscope.

The normal heartrate for a new born is 110-160 bpm. If the infant's heart is not beating at all, the infant receives a 0 for the heart rate category; If the infant's heart rate is less than 100/min the infant receives a 1. If the heart rate is more than 100/min the infant receives a 2.

Step 2: Assess the Neonate's Respiratory Efforts. 1 Minute & 5 Minutes After Birth.

Observe the infant to determine the respiratory efforts of the newborn. Also, observe the movement of the infant's chest wall.

If the infant is not breathing, the infant will receive a 0 for the respiratory effort category; if the infant has a weak cry the infant receives a 1, meaning that the respirations are irregular/slow. If the infant has a good cry, the infant receives a 2, meaning respirations are normal rate and effort.

Step 3: Assess the Neonate's Muscle Tone. 1 Minute and 5 Minutes After Birth.

Observe the newborn's body posture to determine muscle tone.

If the infant is limp or flaccid, the infant receives a 0; if the infant has some flexion of the extremities, the infant receives a 1. If the infant is well flexed, the infant receives a 2, which indicates good muscle tone.

Step 4: Assess the Neonate's Reflex Irritability. 1 Minute and 5 Minutes After Birth.

Observe the newborn's reflex irritability while suctioning the infant's nose or pharynx using a bulb syringe.

If the infant does not have a response of irritability, the infant receives a 0 in the reflex irritability category; if the infant grimaces, the infant receives a 1. If the infant cry, cough, or sneeze, the infant receives a 2, indicating good reflex irritability.

Step 5: Assess the Neonate's Color. 1 Minute & 5 Minutes After Birth.

Observe the color of the newborn's skin.

If the infant's entire body is blue, pale, the infant receives a 0; If the infant's body is pink and the extremities are blue, the infant receives a 1. If the infant's entire body is completely pink, the infant receives a 2, which indicates normal color.