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February 24, 2020

It’s Time to Reevaluate the Apgar Score

Author Affiliations
  • 1Saxony Center for Feto-Neonatal Health, Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
  • 2Children’s Hospital of Richmond, Division of Neonatal Medicine, Virginia Commonwealth University, Richmond
JAMA Pediatr. 2020;174(4):321-322. doi:10.1001/jamapediatrics.2019.6016

When Virginia Apgar, MD, proposed her now-universal scoring system for newborns in 1953, her primary purpose was to get attention paid to the newborn because, as she wrote, “Nine months observation of the mother surely warrants one-minute observation of the baby.”1 After the national Collaborative Perinatal Study showed that low Apgar scores occurred more frequently in those who died in the neonatal period or had higher rates of neurological morbidity at 1 year of life, the Apgar score spread to where it is now assigned to newborns in almost every country in the world. A PubMed search for Apgar score yields almost 12 000 publications.

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2 Comments for this article
Re-evaluating APGAR score
Jose Perez, MD | Halifax Health Hospital
Excellent commentary. I would suggest modifying the current APGAR score to better reflect today's resuscitation standards.
Modification include:
1. HR score should be based on an oximeter or ecg lead measurement.
2. Color score should be replaced by target SpO2. This would allow for more accurate and valid scoring.
3. Remove the 1 minute score altogether or make it a 2 minute score. Delivery room teams have incorporated 30 seconds- 1 minute delayed cord clamping (DCC) in their delivery room practice. The 1 minute APGAR is virtually impossible if a 1 minute DCC is performed.
Lastly, the 10 minute score would be better important than the 5 minute score. It would allow us best opportunity to assess the newborn.

Jose A. Perez, MD, MBA
NICU Medical Director
Halifax Health
Daytona Beach, FL
Reevalute the Apgar Score
Charles brill, MD | Retired, Pediatric Neurologist, duPont Hospital for Children, Thomas Jefferson University Hospital
Virginia Apgar was Professor of Anesthesiology at Columbia University, College of Physicians and Surgeons, when I was a medical student, Class of 1961. No baby got an Apgar Score of 10, since they all had acrocyanosis. The medical students, rotating on OB, gave the Apgar Score, under the supervision of trained OB nurses.