Apgar score imprecision

Article Outline

• Copyright

The Apgar score is used worldwide to assess the newborn clinically and to document for the medical record the status of infants at birth. The limitations of the Apgar score to predict outcomes and the poor reproducibility of the score in clinical practice has been noted previously. Yet, the Apgar score is a rite of passage for the infant and a standard of care for the provider. O’Donnell et al have rigorously evaluated Apgar scoring using videos of infants taken at 5 minutes of age. Personnel from a tertiary neonatal unit scored the infant videos inconsistently, and the scores assigned clinically to the infants were at striking variance from the video scores. The simple truth is that Apgar scores are as often “influenced” by subjective factors as objective assessments. In an editorial, Keenan hopes that improved training will improve the consistency of Apgar scoring. Apgar scores at best force caregivers to “look at” the newborn at about 1 and 5 minutes to assess two essential physiological functions: heart rate and breathing. That is good for the infants.