Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The Apgar score is a system used by doctors and midwives to assess your newborn baby’s health at birth. It helps medical staff decide if your baby needs medical or emergency care.
The Apgar score is a test used by doctors, midwives and nurses to assess your baby’s health at birth. It helps medical staff decide if your baby needs emergency care.
What is the Apgar score?
The Apgar score is a measure of a baby’s condition after birth.
It helps doctors, midwives and nurses to decide if a baby needs immediate treatment or monitoring.
The Apgar score is used to check a newborn baby at 1 minute and 5 minutes after birth.
The test is named after Dr Virginia Apgar who developed the score in 1952.
What does the Apgar score measure?
The Apgar score rates your baby’s:
- skin colour
- heart rate
- reflexes and responsiveness
- muscle tone
- breathing rate
Each feature is scored from 0 to 2, with 2 being the best score. The scores for each feature are added up to give a total Apgar score out of 10.
What do the Apgar scores mean?
An Apgar score of 7 or more, 5 minutes after birth, shows that your baby is adapting well after birth.
However, a score below 7 at 5 minutes is considered low.
If your baby's score was low in the first Apgar test and hasn't improved in the second test at 5 minutes, the doctors, midwives and nurses will continue to closely monitor your baby and provide the necessary medical care.
What if my baby scores low on the Apgar test?
If your baby has a low Apgar score, the medical team will decide if your baby needs extra medical help such as assistance to breath.
The Apgar score is just one piece of information doctors, midwives and nurses use to assess your baby shortly after birth.
If you have any concerns, speak with your doctor, midwife or nurse.
If you would like more information about the Apgar score, you can call Pregnancy Birth and Baby on 1800 882 436.
All parents are offered a thorough physical examination for their baby within 72 hours of giving birth. The examination includes screening tests to find out if your baby has any problems with their eyes, heart, hips and, in boys, testicles (testes). The newborn physical examination is usually carried out in hospital before you go home. Sometimes it's done at a hospital or community clinic, GP surgery, children's centre or at home. Ideally, both parents should be there when the examination is done. The healthcare professional doing the examination should explain what it involves. This could be a doctor, midwife, nurse or health visitor who's been trained to do the examination.
Some parts of the examination may be a bit uncomfortable for your baby, but it will not cause them any pain.
The aim is to spot any problems early so treatment can be started as soon as possible. Usually, nothing of concern is found.
If the healthcare professional doing the examination does find a possible problem, they may refer your baby for more tests.
You'll be offered another physical examination for your baby at 6 to 8 weeks, as some of the conditions it screens for can take a while to develop.
This 2nd examination is usually done at your GP surgery.
The healthcare professional will give your baby a thorough physical examination.
They'll also ask you questions about how your baby is feeding, how alert they are, and about their general wellbeing.
Your baby will need to be undressed for part of the examination.
During the examination, the healthcare professional will also:
- look into your baby's eyes with a special torch to check how their eyes look and move
- listen to your baby's heart to check their heart sounds
- examine their hips to check the joints
- examine baby boys to see if their testicles have descended into the scrotum
The examination includes an overall physical check, plus 4 different screening tests.
Eyes
The health professional will check the appearance and movement of your baby's eyes.
They're looking for cataracts, which is a clouding of the transparent lens inside the eye, and other conditions.
About 2 or 3 in 10,000 babies are born with cataracts in one or both eyes that need treatment.
But the examination cannot tell you how well your baby can see.
Find out more about childhood cataracts
Heart
The healthcare professional will check your baby's heart. This is done by observing your baby, feeling your baby's pulses, and listening to their heart with a stethoscope.
Sometimes heart murmurs are picked up. A heart murmur is where the heartbeat has an extra or unusual sound caused by a disturbed blood flow through the heart.
Heart murmurs are common in babies. The heart is normal in almost all cases where a murmur is heard.
But about 8 in 1,000 babies have congenital heart disease that needs treatment.
Find out more about congenital heart disease
Hips
Some newborns have hip joints that are not formed properly. This is known as developmental dysplasia of the hip (DDH).
Left untreated, DDH can cause a limp or joint problems.
About 1 or 2 in 1,000 babies have hip problems that need to be treated.
Find out more about developmental dysplasia of the hip
Testicles
Baby boys are checked to make sure their testicles are in the right place.
During pregnancy, the testicles form inside the baby's body. They may not drop down into the scrotum until a few months after birth.
Around 2 to 6 in 100 baby boys have testicles that descend partially or not at all.
This needs to be treated to prevent possible problems later in life, such as reduced fertility.
Find out more about undescended testicles
The aim of the examination is to identify any of the problems early so treatment can be started as soon as possible.
It's strongly recommended for your baby, but not compulsory.
You can decide to have your baby examined and screened for any or all of the conditions.
If you have any concerns, you should talk to your midwife or the healthcare professional offering the examination.
The healthcare professional who does the examination will give you the results straight away.
If your baby needs to be referred for more tests, they'll discuss this with you there and then, too.
The results will be recorded in your baby's personal child health record (red book).
You'll need to keep this safe and have it to hand whenever your baby sees a healthcare professional.
If you have any concerns, you can discuss them with your midwife or the healthcare professional who does the examination.
Download a leaflet about screening tests for you and your baby from GOV.UK
Though most babies are born healthy and stay that way, a very small percentage are apparently healthy at birth and then get sick because of a metabolic disorder — which can be potentially life-threatening if left undetected and untreated.
Other babies are born with various rare but serious conditions, like a congenital heart condition. Luckily, inexpensive tests can catch all of these conditions early, and proper treatment can, in many cases, save lives.
The following screening tests and procedures will make sure your little one gets the healthiest start to life.
How many tests and screenings will my newborn need in total?
The number of newborn screenings your baby will receive varies by state, but one blood draw that screens for at least 21 serious genetic, metabolic, hormonal and functional disorders is required by law. The U.S. Department of Health and Human Services (HHS) recommends screening for 35 core and 26 secondary conditions to check for a total of 61 different disorders.
Your baby will also likely receive several other basic screenings designed to detect other issues, like congenital heart defects and impaired hearing.
What kind of tests will my newborn baby get?
The newborn screenings your baby will most likely undergo include:
A rating on the Apgar scale
This simple and essential assessment of baby’s condition is done between one and five minutes after birth.
A congenital heart disease screening
The Centers for Disease Control and Prevention (CDC) also recommends, and some states require, screening tests soon after birth for congenital heart defects. This condition, which affects 1 in 100 babies, can lead to disability or death if not caught and treated in time.
Happily, when a baby gets a diagnosis and treatment early, those risks are reduced significantly and, in most cases, completely.
21 or more types of blood screens
A single blood test looks for at least 21 serious genetic, metabolic, hormonal and functional disorders, including PKU, hypothyroidism, congenital adrenal hyperplasia, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, medium-chain acyl-CoA dehydrogenase deficiency and sickle cell anemia.
Although most of these conditions are very rare, they can be life-threatening if they go undetected and untreated.
A hearing test
For 2 to 4 out of every 1,000 babies born each year in the U.S., the sense of hearing — so integral to the development of speech and language — is impaired.
Since a deficit can affect so many aspects of a child’s development, early diagnosis and treatment are key, which is why the American Academy of Pediatrics (AAP) endorses the test for all newborn babies.
A physical examination and preventive treatments
In addition to conducting the core newborn screening tests during your baby's hospital stay, your doctor, midwife or nurse will most likely also:
- Weigh baby and measure his length and head circumference
- Count fingers and toes and note if any body parts and features appear abnormal
- Examine baby's internal organs, including kidneys, liver and spleen, externally by touch
- Check your newborn's reflexes, hip rotation and umbilical stump
- Record your baby's first pees and poops to rule out elimination issues
- Administer antibiotic eye ointment to prevent infection, a vitamin K injection and the first dose of the hepatitis B vaccine sometime before hospital discharge
How is my baby tested?
Within the first 24 to 48 hours after birth, your baby will most likely undergo the following procedures:
Blood test
To test for more than 21 possible metabolic, genetic, hormonal and functional disorders, a few drops of blood are routinely taken using a single heel stick test usually 24 to 48 hours after birth.
Congenital heart disease screening
This screening, using pulse oximetry, is simple and painless. A sensor is placed on your baby’s skin to measure your little one’s pulse and the amount of oxygen in his blood.
If the results of the screening seem questionable, the doctor will request further testing (like an echocardiogram or an ultrasound of the heart) to determine if anything is wrong.
Newborn hearing screening
One test, called otoacoustic emissions (OAE), measures response to sound by using a small probe inserted in baby’s ear canal.
In babies with normal hearing, a microphone inside the probe records faint noises coming from the baby’s ear in response to a noise produced by the probe. The test can be done while baby is sleeping, is completed within a few minutes and causes no pain or discomfort.
A second screening method, called auditory brainstem response (ABR), uses electrodes placed on baby’s scalp to detect activity in the brain stem’s auditory region in response to "clicks" sounded in the newborn's ear.
ABR screening requires the infant to be awake and in a quiet state, but it’s also quick and painless. If your baby doesn’t pass the initial screening, the test will be repeated to avoid false-positive results.
What is the Apgar test?
The Apgar test is the first screening most newborns are given; the scores — rated on a scale of 0 to 10, and taken one minute and again five minutes after birth — reflect baby’s general condition.
They’re based on observations made in five assessment categories: appearance, pulse, reflexes, muscle tone and breathing.
What is the vitamin K shot?
Since most babies are born with low levels of vitamin K, they'll get a vitamin K shot within six hours of birth to enhance their blood-clotting ability and prevent a potentially dangerous condition from cropping up.
Will my baby require every test? Can I opt out of newborn screening tests?
All 50 states and the District of Columbia require a newborn blood screening for at least 21 disorders, with many states screening newborns for the 61 disorders suggested by the HHS and sometimes a few additional ones.
Check with your practitioner or your local board of health to find out what tests are done in your state, or look them up online at Baby's First Test (a newborn screening clearinghouse funded by the Maternal and Child Health Bureau, a branch of the Health Resources & Services Administration).
If you’re concerned, discuss your fears at a prenatal visit — don’t wait until delivery day to speak up. You do have the right to opt out of any test or procedure, but you will need to sign paperwork documenting your decision.
In some cases, the hospital might inform the state’s department of child services that you’ve decided to forgo the recommended screening.
Keep in mind, although most of these conditions are very rare, they can be life-threatening if they go undetected and untreated. Testing is inexpensive, and in the very unlikely event that your baby tests positive for any condition, the pediatrician can verify the results and begin treatment immediately, making a huge difference in the prognosis.
It's in your child's best interest to get all the screenings your pediatrician and hospital recommend.
Will my baby need more tests than the required screenings?
Certain states require additional "secondary" newborn screenings in their heel-stick tests, sometimes because of an at-risk population in the area. To check which conditions must be tested for in your state, visit Baby's First Test.
Will my insurance cover all the newborn screening tests?
Under the Affordable Care Act, your insurance is required to cover the following newborn screenings:
- Congenital hypothyroidism
- Sickle cell anemia
- PKU
- Hearing screening
There’s a good chance your insurance will cover all the other blood tests as well as the one for congenital heart defects, so be sure to check.
Can I ask for more newborn screening tests?
If your hospital doesn’t automatically provide all 35 core newborn blood tests recommended by the HHS, you can arrange to have them done. Talk to your doctor, then check with your insurance to calculate your out-of-pocket costs, if any.
If your state doesn’t require screening for congenital heart disease, ask your baby’s pediatrician if your little one can get tested.