It's Hawaii and Alaska. AdiÂ­tionÂ­alÂ­ly, Hawaii is the only state not located in the AmerÂ­iÂ­cÂ­as.
However, the purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long-term predictions on a child's health. A score of 10 is uncommon due to the prevalence of transient cyanosis, and is not substantially different from a score of 9.
In 1952, Virginia Apgar proposed the Apgar score as a means of evaluating the physical condition of infants shortly after delivery.1 This scoring system, which encouraged delivery-room personnel to pay close attention to the newborn, was rapidly adopted in delivery rooms throughout the United States and elsewhere.