Apgar scoring system was developed by Virginia Apgar, a physician and anesthesiologist, in 1952. The purpose of this scoring system was to evaluate the condition of a newborn child at birth. According to the Apgar system, infants are evaluated based on five variables: heart rate, respiratory effort, muscle tone, reflex irritability, and color. A numerical score ranging from 0 to 2 is assigned in each category, thus the maximum possible score is 10. 

This is the way Apgar Scoring System was described by V.Apgar:

Scores are interpreted as follows:

7-10 Normal

4-6 Moderately Depressed

0-3 Severely Depressed 

Apgar scores cannot be used to predict long-term developmental and/or neurological outcomes because these scores were never intended to be used for this purpose.The goal of the scoring system was to ensure that certain infants were observed for their need for immediate care at birth. American College of Obstetricians and Gynecologists recommends use of the Apgar score for the mere purpose of assessment of newborn’s condition at birth. Apgar score is not approved as the only measure of evaluating the possibility of neurological damage during birth. 

The consistency of the Apgar scores tends to vary. According to Clark & Hakanson studies (in which images of infants and their case presentation was provided to the health professional who then assigned an Apgar score), pediatricians had a consistency rating of 68%, obstetricians – a rating of 42%, and  obstetric nurses – a rating of 36%. In 1990, another attempt was undertaken to determine how consistently two health care providers would rate an infant based on the Apgar system. Not surprisingly, the heart rate metric had the best consistency of all since all health care providers would agree on what is being measured and how to interpret the measurements. Another factor affecting consistency of ratings is whether the infant is “term” or “preterm”. Term infants are often categorized as “normal”, which may result in a higher Apgar score. By the same token, “preterm” infants who are often perceived by the health care team as “not normal” may receive lower Apgar scores. Another concern related to consistency of ratings has to do with the person who assigns the score. According to Virginia Apgar, the person delivering the baby should not be the one assigned the rating score since they have a vested interest in the outcome of birth & delivery. Finally, if the health professional needs to assign Apgar scores from memory, this will inevitably affect the accuracy of ratings. 

Some parents may mistakenly believe that if their child was assigned an Apgar score of 9, there is something wrong with the child. It is important to understand that normal Apgar scores range from 7 to 10 and that it is actually infrequent for a newborn to receive a score of 9 because most infants will have some blueness to their extremities at birth and won’t be completely pink. 

If your child received an Apgar score of 9 at birth, congratulations! It is a perfectly normal score.