Unifying Concepts

The Apgar Score

The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed.
Apgar Score and Resuscitation

The 5-minute Apgar score, and particularly a change in the score between 1 minute and 5 minutes, is a useful index of the response to resuscitation. If the Apgar score is less than 7 at 5 minutes, the Neonatal Resuscitation Program guidelines state that the assessment should be repeated every 5 minutes for up to 20 minutes. However, an Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant.

Component of backronym

  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respiration

The five criteria of the Apgar score:

Sign 0 1 2 1 min 5 min
Color blue or pale acrocyanosis completely pink
Pulse rate absent < 100 beats per minute > 100 beats per minute
Reflex irritability no response grimace cry or active withdrawal
Muscle tone limp some flexion active motion
Respiration absent weak cry, hypoventilation good, crying


Minutes 1 5 10 15 20
Chest compressions

Expanded Apgar score reporting form.
Scores should be recorded in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported by using a check mark in the appropriate box. The comment box is used to list other factors, including maternal medications and/or the response to resuscitation between the recorded times of scoring. ETT, endotracheal tube; PPV/NCPAP, positive pressure ventilation/nasal continuous positive airway pressure.
The Apgar score describes the condition of the newborn infant immediately after birth and, when properly applied, is a tool for standardized assessment. It also provides a mechanism to record fetal-to-neonatal transition. Apgar scores do not predict individual mortality or adverse neurologic outcome. However, based on population studies, Apgar scores of less than 5 at 5 minutes and 10 minutes clearly confer an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy. Most infants with low Apgar scores, however, will not develop cerebral palsy. The Apgar score is affected by many factors, including gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions. If the Apgar score at 5 minutes is 7 or greater, it is unlikely that peripartum hypoxia–ischemia caused neonatal encephalopathy.



  1. American Academy of Pediatrics, Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists and Committee on Obstetric Practice. The Apgar Score. Pediatrics 2015 Oct;136(4):819-22. [Medline]
  2. Dalili H, Nili F, Sheikh M, Hardani AK, Shariat M, Nayeri F. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS One. 2015 Mar 26;10(3):e0122116. [Medline]
  3. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260-7. [Medline]


Created Jun 08, 2018

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