[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
Viewpoint
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.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    2 Comments for this article
    EXPAND ALL
    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.
    4.
    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
    CONFLICT OF INTEREST: None Reported
    READ MORE
    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.
    CONFLICT OF INTEREST: None Reported
    ×