 Apgar Scoring in the Newborn Apgar Scoring was developed in 1953 by Dr. Virginia Apgar, who described five signs that could be determined easily and without interfering with the care of the infant. A rating of zero, one, or two is given to each sign depending on whether it is absent or present. A score of ten indicates a baby in the best possible condition. The judging of the five objective signs is generally done at one minute of age after delivery and at five minutes of age. A score of seven to ten is considered normal, while four to seven might require some resuscitative measure. A score of three and below requires immediate resuscitation. This chart indicates each of the signs and scores. Apgar Scoring for Newborns The Apgar score was published in 1953. Ten years later, an acronym was reported in the Journal of the American Medical Association that helped teach the Apgar score by using the letters A, P, G, A, and R. This acronym was co-authored by Dr. Joseph Butterfield. Activity Muscle Tone Muscle Tone refers to the amount of active motion of the extremities. A score of zero indicates a newborn who is limp and without movement. A score of one indicates a newborn has some flexion of the extremities. A score of two is an excellent score which indicates spontaneous movement of arms and legs that resist extension. Pulse refers to the heart rate of the newborn during the time of scoring. The heart rate is determined by placing a stethoscope on the newborn's chest listening for the heart rate. A score of zero indicates that there is no heart rate. A score of two indicates that there is a heart rate of 100 to 140. Reflex Irritability Reflex Irritability refers to a response to some form of stimulation such as suctioning the nose and mouth. Suctioning with a bulb syringe after delivery to clear the airway often elicits a response of facial grimacing, sneezing, or coughing. A score of zero indicates that there is no response to any stimulation. A score of one indicates that there is slight grimacing with no sneezing or coughing with stimulation. A score of two indicates that there is grimacing, sneezing, coughing, crying, or vigorous movement with stimulation. All infants are cyanotic at birth because of their high capacity for carrying oxygen and the low oxygen saturation in their blood. The disappearance of cyanosis depends on respiratory effort and heart rate. A score of zero indicates that the infant remained gray, pale, or obviously cyanotic over the trunk and extremities. A score of one indicates that the infant's skin color is pink with the exception of the hands and feet. This is called acrosionosis. Acrosionosis is very common and can occur in spite of excellent ventilation. Most infants fall into this category. A score of two indicates a newborn's entire body and extremities are pink. Respiratory effort, this refers to the newborn's respiratory effort at 60 seconds and 5 minutes of age. A score of zero indicates that there is no respiratory effort. This is referred to as apnea. A score of one indicates that there is irregular shallow ventilation or a gasp once at 30 or 45 seconds after birth. A score of two indicates that there is regular breathing and or a lusty cry. You have completed this learning activity, apgar scoring in the newborn.