How the APGAR score is calculated
Five signs of newborn wellbeing are each scored 0–2 and summed, conventionally assessed at 1 and 5 minutes after birth (and repeated every 5 minutes if <7).
| Sign | 0 points | 1 point | 2 points |
|---|---|---|---|
| Appearance (colour) | Blue/pale all over | Body pink, extremities blue | Pink all over |
| Pulse (heart rate) | Absent | <100/min | ≥100/min |
| Grimace (reflex irritability) | No response | Grimace | Cries / withdraws |
| Activity (muscle tone) | Limp | Some flexion | Active motion |
| Respiration | Absent | Weak / irregular | Good, crying |
Normal values
| Score | Interpretation |
|---|---|
| 7 – 10 | Reassuring |
| 4 – 6 | Moderately depressed — stimulate, consider supplemental oxygen |
| 0 – 3 | Severely depressed — begin resuscitation per NRP algorithm |
Clinical use
APGAR gives a quick, structured snapshot of a newborn's transition to extrauterine life and standardises communication between the delivery team. It guides the immediate response but is not, on its own, predictive of long-term neurological outcome, and a low score should never delay resuscitation while it's being calculated — resuscitation follows the Neonatal Resuscitation Program (NRP) algorithm in real time, and the APGAR score is recorded alongside it.
Frequently asked questions
What is the APGAR score?
A 0–10 score assessing a newborn's colour, heart rate, reflex response, muscle tone, and breathing effort at 1 and 5 minutes after birth, used to guide the immediate need for resuscitation.
What is a good APGAR score?
7–10 is reassuring. 4–6 is moderately depressed and may need stimulation or oxygen. 0–3 is severely depressed and requires immediate resuscitation per the NRP algorithm.
When is the APGAR score taken?
At 1 minute and 5 minutes after birth, and repeated every 5 minutes thereafter if the score remains below 7.
Does a low APGAR score mean long-term problems?
Not necessarily — APGAR gives a snapshot of immediate transition to life outside the womb and guides the immediate resuscitation response, but on its own it isn't strongly predictive of long-term neurological outcome.
References
- Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32:260–267.
- American Academy of Pediatrics & ACOG. The Apgar Score. Committee Opinion No. 644. Obstet Gynecol. 2015;126:e52–e55.
- American Heart Association / AAP. Neonatal Resuscitation Program (NRP) 8th Edition, 2020.