European Journal of Epidemiology

, Volume 34, Issue 2, pp 103–104 | Cite as

The Apgar paradox

  • Henning TiemeierEmail author
  • Marie C. McCormick

Most of today’s readers of this journal will have received an Apgar score 1 and 5 min after birth. The measure was introduced by Virginia Apgar, an anesthesiologist, in 1952; and, since the 1960s, it is popular world-wide. The Apgar score is now ubiquitously used in newborns and arguably the most common composite screening instrument in medicine and only a few single measure screening procedures such as growth curves, glucose levels or blood pressure are more frequently employed.

In the Apgar score, neonates are assigned a numerical score of 0–2 for heart rate, respiratory rate, skin color, muscle tone, and response to stimuli resulting in a score of 0–10. The score is measured at specific periods after birth, generally 1, 5 and 10 min. The score at 1 min reflects successful transition from the womb; that at 5 min the successful adaptation to extra-uterine life, with or without medical intervention. Generally, a score of < 7 at 5 min is considered to present a risk of poor birth...


  1. 1.
    Modabbernia A, Sandin S, Gross R, Leonard H, Gissler M, Parner ET, Francis R, Carter K, Bresnahan M, Schendel D, Hornig M. Apgar score and risk of autism. Eur J Epidemiol. 2019. Scholar
  2. 2.
    Modabbernia A, Mollon J, Boffetta P, Reichenberg A. Impaired gas exchange at birth and risk of intellectual disability and autism: A meta-analysis. J Autism Dev Disord. 2016;46(5):1847–59.CrossRefGoogle Scholar
  3. 3.
    Hoevenaars-van den Boom MA, Antonissen AC, Knoors H, Vervloed MP. Differentiating characteristics of deafblindness and autism in people with congenital deafblindness and profound intellectual disability. J Intellect Disabil Res. 2009;53(6):548–58.CrossRefGoogle Scholar
  4. 4.
  5. 5.
    Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. JAMA. 2003;290(13):1763–6.CrossRefGoogle Scholar
  6. 6.
    American Academy of Pediatrics. American college of obstetricians and gynecologists, committee on obstetric practice. The Apgar score. Pediatrics. 2006;117(4):1444–7.CrossRefGoogle Scholar
  7. 7.
    Constantino JN, Kennon-McGill S, Weichselbaum C, Marrus N, Haider A, Glowinski AL, Gillespie S, Klaiman C, Klin A, Jones W. Infant viewing of social scenes is under genetic control and is atypical in autism. Nature. 2017;547(7663):340.CrossRefGoogle Scholar
  8. 8.
    Denisova K, Zhao G. Inflexible neurobiological signatures precede atypical development in infants at high risk for autism. Sci Rep. 2017;7(1):11285.CrossRefGoogle Scholar
  9. 9.
    Serdarevic F, Ghassabian A, van Batenburg-Eddes T, White T, Blanken LM, Jaddoe VW, Verhulst FC, Tiemeier H. Infant muscle tone and childhood autistic traits: a longitudinal study in the general population. Autism Res. 2017;10(5):757–68.CrossRefGoogle Scholar
  10. 10.
    Richardson Douglas K, et al. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr. 2001;138(1):92–100.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Social and Behavioral ScienceHarvard TH Chan School of Public HealthBostonUSA

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