The APGAR score
Dr. Virginia Apgar described this assessment in 1952 as a quick, standardised way to evaluate newborns immediately after delivery. The acronym was retrofitted later: Appearance, Pulse, Grimace, Activity, Respiration. Each criterion scores 0, 1, or 2. Maximum total is 10.
It's assessed at exactly 1 minute and 5 minutes of life. The 1-minute score reflects the stress of delivery and immediate transition. The 5-minute score is what actually predicts outcomes, particularly neurological ones. A baby with a low 1-minute score but a good 5-minute score is usually doing fine.
APGAR criteria reference
| Criterion | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Appearance (colour) | Blue/pale all over | Body pink, extremities blue | Pink all over |
| Pulse (heart rate) | Absent | <100 bpm | ≥100 bpm |
| Grimace (reflex irritability) | No response | Grimace | Cry, cough, or sneeze |
| Activity (muscle tone) | Limp | Some flexion | Active motion |
| Respiration | Absent | Weak, irregular | Strong cry |
Score interpretation
| Score | Classification | Action |
|---|---|---|
| 7-10 | Normal | Routine care. Dry, warm, stimulate. |
| 4-6 | Moderate depression | Supplemental oxygen, stimulation, consider positive pressure ventilation. |
| 0-3 | Severe depression | Immediate resuscitation. Positive pressure ventilation, cardiac compression if HR <60. |
What APGAR doesn't tell you
A single APGAR score doesn't predict long-term outcomes for individual babies with any reliability. A score of 7 in a premature infant carries different significance than in a term baby. The score is also influenced by gestational age, maternal sedation, and congenital anomalies.
A 5-minute score below 7 warrants continued assessment every 5 minutes until 20 minutes or until two consecutive scores of 7 or above. A score that remains below 3 at 10-20 minutes is associated with poor neurological outcomes and guides decisions about continued resuscitation.
Related tools on MediCalc Pro
For weight-based drug dosing in neonates and infants, see Pediatric Dose Calculator. For fluid requirements (Holliday-Segar), see Pediatric Fluid Requirement. For growth percentiles, see Growth Chart Percentile. For the obstetric context, see Due Date Calculator and Gestational Weight Gain.
References
- Apgar V. "A proposal for a new method of evaluation of the newborn infant." Curr Res Anesth Analg. 1953;32(4):260-267.
- American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation. 8th ed. 2021.
- Papile L-A, et al. "The APGAR score." Pediatrics. 2015;136(4):819-822.