Paediatrics
APGAR Score
Rapid assessment of newborn condition after birth.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
The APGAR score is a rapid, standardised assessment of a newborn's condition immediately after birth and of the response to any resuscitation. It scores five signs from 0 to 2 each — Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone) and Respiration — giving a total out of 10. It is recorded at 1 and 5 minutes of age, and continued every 5 minutes if the baby remains compromised. The acronym conveniently maps to its components.
Interpreting the result
A score of 7–10 is reassuring and reflects a baby in good condition. A score of 4–6 is moderately abnormal and may indicate the need for support and reassessment. A score of 0–3 is low and signals a baby who needs active resuscitation. The trend between the 1- and 5-minute scores is often more informative than a single value, as it tracks the response to intervention.
Worked example
A newborn at 1 minute is centrally pink with blue extremities (1), has a heart rate above 100 (2), grimaces to stimulation (1), shows some flexion (1) and has a weak, irregular cry (1), giving an APGAR of 6 — moderately abnormal, prompting support and a repeat score at 5 minutes.
Pearls / pitfalls
- It describes the newborn's condition; it does not, on its own, direct resuscitation, which follows structured newborn-life-support algorithms based mainly on heart rate and breathing.
- The change between the 1- and 5-minute scores often matters more than either single number, reflecting response to support.
- It is not a reliable predictor of long-term neurological outcome and should not be used to diagnose birth asphyxia.
- Preterm babies may score lower due to immaturity (especially tone and colour), independent of acute compromise.
Evidence & validation
Devised by Virginia Apgar to standardise newborn assessment and adopted worldwide. It is embedded in neonatal resuscitation and newborn-life-support guidance, with the important caveat that it should not be used in isolation to direct resuscitation, which follows structured algorithms.
Frequently asked questions
What is a normal APGAR score?
A score of 7–10 is reassuring. A score of 4–6 is moderately abnormal and 0–3 is low, indicating a baby who needs active resuscitation. The score is recorded at 1 and 5 minutes.
Does a low APGAR mean brain damage?
No. A low score reflects the baby's condition at that moment and the response to resuscitation. It is not a reliable predictor of long-term neurological outcome and should not be used alone to diagnose birth asphyxia.
Why is it scored at 1 and 5 minutes?
The 1-minute score captures the initial condition and the 5-minute score the response to any support given. If the baby remains compromised, scoring continues every 5 minutes to track progress.
Does the APGAR score guide resuscitation?
Not directly. Resuscitation follows structured newborn-life-support algorithms driven mainly by heart rate and breathing. The APGAR documents the baby's condition and response rather than dictating the steps.
Why might a premature baby score lower?
Preterm infants often have lower muscle tone and reflex responses due to immaturity, which can reduce the score independently of any acute problem. The score is interpreted in the context of gestational age.
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 Committee on Fetus and Newborn. The Apgar Score. Pediatrics. 2015;136(4):819–822.
About the creator
Virginia Apgar
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