An Apgar score that remains 0 beyond 10 minutes may be useful in determining if the termination of resuscitation efforts is appropriate, as very few newborn infants with an Apgar score of 0 at 10 minutes survive with normal neurologic outcomes.When a newborn infant has an Apgar score of 5 or more at 5 minutes, an umbilical arterial blood sample from a clamped section of the umbilical cord should be obtained, if possible.A recent population-based cohort study in Sweden found an increased risk of cerebral palsy and seizures with lower Apgar scores at 5 and 10 minutes.This increased risk is as high as 20- to 100-fold higher than infants with 5-minute Apgar scores of 7-10. 1-3 However, based on population studies, Apgar scores less than 5 at 5 and 10 minutes confer an increased relative risk of cerebral palsy in large populations. Most newborn infants with low Apgar scores do not go on to develop cerebral palsy. The Apgar score does not predict individual neonatal mortality or neurologic outcomes. The ACOG Task Force on Neonatal Encephalopathy defines the 5-minute Apgar score of 0-3 as low and concerning, 4-6 as moderately abnormal, and 7-10 as reassuring.Apgar scores alone should not be used to establish a diagnosis of asphyxia.A low Apgar score at 1 minute does not predict adverse clinical outcomes as it will likely improve by 5 minutes.It should not be used to guide resuscitative efforts. The Apgar score only reflects a newborn infant’s clinical status at one point in time and includes subjective components.If a newborn infant’s Apgar score at 5 minutes is less than 7, it should be repeated every 5 minutes until 20 minutes of life. The Apgar scores are performed at 1 and 5 minutes of life.
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