A SPECIAL REPORT SERIES BY THE N.C. DEPARTMENT OF HUMAN RESOURCES, DIVISION OF
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALEIGH, N.C. 27602
No. 23 NQy j J0p2 ’ October 1932
PREDICTING INFANT MORTALITY:
AN EVALUATION OF APGAR SCORES
INTRODUCTION
The Apgar scoring system is a method of evaluating and rating newborn infants
with respect to their physical condition at one minute and five minutes after
birth. It was developed in 1952 by Dr. Virginia Apgar for the purposes of
"predicting survival, comparing different methods of resuscitation, and comparing
perinatal experiences in different hospitals" (1). The system is based on the
observation, and the subsequent rating, of five selected signs of an infant's
physical health at birth. These signs are heart rate, respiratory effort, muscle
tone, reflex response, and color. Each sign is given a score of 0, 1 or 2 based
on the performance of the nev£>orn (see Thble 1) . The Apgar score is the sum of
these five 0-2 scores and ranges from 0 to 10, with 10 being the optimum. In the
literature, Apgar scores of 0-3 have generally represented poor condition, 4-6
fair condition, and 7-10 good condition (1, 3-11, 15-16).
In 1978 North Carolina along with 37 other states and the District of Columbia
began to routinely record one- and/or five-minute Apgar scores on birth
certificates (15). These scores ware added to the certificate with the hope that
they provided additional information, although subjective, on the health of
infants at birth and on their chances of survival, i.e., information above and
beyond that available in other after-birth indicators. Numerous studies have been
performed which have shown strong associations among Apgar .score, birth weight,
mortality, and some measures of infant morbidity (1, 3-11, 15). Some have
suggested that Apgar scores, particularly the five-minute scores, in combination
with other known birth characteristics could be used to predict survival (3, 5-6) .
Table 1
The Apgar Scoring Method
Sign
Score
0
1
2
Heart Rate -
— Absent
Below 100/min.
ever 100/min.
Respiratory Effort -
— Absent
Minimal; weak cry
Good; strong
cry
Muscle Tbne -
— Limp
Some flexion of
Active motion;
extremities
extremities
wall-flexed
Reflex Irritability -
— No response
Some motion
Cry
Color -
— Blue or pale
Body pink;
Pink
extremities blue
Source: Apgar, V., et al : Evaluation of the Newborn Infant-Second Report, Journal
of American Medical Association, 168 (15): 1985-1988, December 1958.
