Apgar score not predictive of mortality or neurological outcome

1. The Apgar score evaluates initial infant condition after delivery and helps direct need for any resuscitative measures. This joint policy from the American Academy of Pediatric (AAP) and the American College of Obstetricians and Gynecologists (ACOG) is a reminder that, on an individual level, the Apgar score does not determine neonatal mortality, neurological outcome, or an asphyxial event.

2. Use of a standardized expanded Apgar score reporting form is recommended to reduce interrater variability and appropriately document timing of resuscitative efforts.

Statement Rundown: Dr. Virginia Apgar introduced the Apgar score in 1952; this standardized scoring system evaluates newborns shortly after delivery to assess initial condition and response to any resuscitative measures. All infants are given a score between 0 and 10 at 1- and 5-minutes of life, with continued scoring till 20 minutes of life for infants with 5-minute scores of 7 or less. Scoring measures include color, heart rate, reflexes, muscle tone, and respiration. This joint policy statement from the AAP Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice validates that while the Apgar score is an appropriate measure of initial infant condition and response to resuscitation, it should not be used as a predictor of mortality or neurological outcome in individual infants. The Apgar score alone is additionally not indicative of asphyxia, a diagnosis of perinatal hypoxic-ischemic event that entails a multimodal approach including the clinical exam, laboratory tests, imaging, and EEG. The policy statement suggests that infants with a 5-minute Apgar score of 5 or less have umbilical artery blood gas evaluation from the clamped umbilical cord and possibly placental pathological examination. Furthermore, the use of a standardized expanded Apgar score reporting form is recommended to reduce interrater variability.

Click to read the policy statement, published in Pediatrics

Relevant Reading: The Continuing Value of the Apgar Score for the Assessment of Newborn Infants

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