APGAR score
Newborn status at 1 and 5 minutes after birth
- AAP/ACOG 2015
Sources last checked: 2026-10-13
APGAR score
Newborn status at 1 and 5 minutes after birth
AAP/ACOG 2015: resuscitation is not delayed until the 1-minute score is assigned. The APGAR alone does not diagnose asphyxia and does not predict an individual infant's neurological outcome. A score given during resuscitation is not equivalent to one in a spontaneously breathing infant; preterm infants score lower on tone and reflexes.
Interpretation
| 0–3 — low | AAP/ACOG: low score. At 5 minutes associated with higher neonatal mortality in populations — not a predictor for the individual infant. |
|---|---|
| 4–6 — moderately abnormal | AAP/ACOG: moderately abnormal. AAP/ACOG describe repeating the score every 5 minutes up to 20 minutes when the 5-minute score is < 7. |
| 7–10 — reassuring | AAP/ACOG: reassuring. |
What is the APGAR score?
The APGAR score was proposed by the anaesthetist Virginia Apgar in 1953 to standardise the assessment of newborns immediately after birth. Five signs — colour, heart rate, reflex irritability, muscle tone and breathing — are each scored 0–2. It is recorded at 1 and 5 minutes and, if the 5-minute score is below 7, every 5 minutes up to 20 minutes.
When to use it
- Documenting the newborn's condition at 1 and 5 minutes after birth
- Describing the response to resuscitation over time
- Teaching and communication between obstetric and neonatal teams
When not to use it
- To decide whether to start resuscitation — that follows the newborn life support algorithm, not the score
- To diagnose asphyxia or predict the neurological outcome of an individual infant
How it is calculated
| Criterion | Points |
|---|---|
| Appearance (colour) | |
| Blue or pale all over | 0 |
| Body pink, extremities blue (acrocyanosis) | 1 |
| Completely pink | 2 |
| Pulse (heart rate) | |
| Absent | 0 |
| < 100 /min | 1 |
| ≥ 100 /min | 2 |
| Grimace (reflex irritability) | |
| No response | 0 |
| Grimace | 1 |
| Cry, cough or sneeze | 2 |
| Activity (muscle tone) | |
| Limp | 0 |
| Some flexion of extremities | 1 |
| Active motion | 2 |
| Respiration | |
| Absent | 0 |
| Weak, irregular, slow | 1 |
| Good, crying | 2 |
Clinical pearls and limitations
- AAP/ACOG 2015: resuscitation is not delayed until the 1-minute score is assigned. The APGAR alone does not diagnose asphyxia and does not predict an individual infant's neurological outcome. A score given during resuscitation is not equivalent to one in a spontaneously breathing infant; preterm infants score lower on tone and reflexes.
- Mnemonic: Appearance, Pulse, Grimace, Activity, Respiration.
- Acrocyanosis is normal in the first minutes; most healthy newborns score 8–9 at one minute.
- Preterm infants and those exposed to maternal sedation score lower without necessarily being compromised.
- AAP and ACOG recommend an expanded form that records concurrent resuscitation measures.
Frequently asked questions
What is a normal APGAR score?
7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.
Does a low APGAR mean brain damage?
No. A low 5-minute score is associated with higher risk in populations, but it does not predict an individual infant's neurological outcome.
When is the APGAR assessed?
At 1 and 5 minutes after birth, then every 5 minutes up to 20 minutes while the score stays below 7.
Evidence and guidelines
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