The Role of Crying Activity in Apgar Scoring

THE APGAR SCORE1is designed to determine the physical condition or viability of the newborn 60 seconds after birth, and it has been established that there is a strong association between low scores and neonatal mortality.1-4Two of the five segments comprising the score involve crying, and the response sought to one of them (respiratory effort) is a "strong cry" (Table 1). The second sign(reflex irritability) lists "cry" in response to a tangential foot slap. The diagnostic value of the cry alone, reported in previous studies,5,6Msuggested the potential importance of its role within the Apgar score; thus, it seemed feasible to isolate for study the two segments, respiratory and reflex, in order to determine their relative contribution to the total score. Since Apgar2has already mentioned that some of the signs of her test may be more discriminative than others, it was decided to compare each of the signs with the other and with the total score. The cry segments and the total score were also compared with an independent measure of the newborn's crying activity taken from magnetic tape recordings made in the delivery room. In this manner, the "on-the-spot" Apgar evaluation of the cry