Virginia Apgar, MD, introduced this scoring system in 1952 to identify neonates who require resuscitation and to assess the effectiveness of such efforts (Raab & Kelly, 2013). Each of the five elements (heart rate, respiratory rate, muscle tone, reflex irritability, and color) are assigned a value of 0-2 at 1 minute and again 5 minutes after delivery. The total score of each element is used to evaluate the condition of the newborn and resuscitative efforts at the time of delivery. Changes in the score between 1 and 5 minutes measure the effectiveness of resuscitative efforts; low scores at 5 minutes are associated with high infant mortality.