Apgar score

Definition of Apgar score. Apgar score: An objective score of the condition of a baby after birth. This score is determined by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs receives 0, 1, or 2 points.


  2. a measure of the physical condition of a newborn infant. It is obtained by adding points (2, 1, or 0) for heart rate, respiratory effort, muscle tone, response to stimulation, and skin coloration; a score of ten represents the best possible condition.
  4. Apgar scoreApgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the doctor how well the baby is doing outside the mother’s womb.

    In rare cases, the test will be done 10 minutes after birth.

    Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.

    How the Test is Performed

    The Apgar test is done by a doctor, midwife, or nurse. The health care provider examines the baby’s:

    • Breathing effort
    • Heart rate
    • Muscle tone
    • Reflexes
    • Skin color

    Each category is scored with 0, 1, or 2, depending on the observed condition.

    Breathing effort:

    • If the infant is not breathing, the respiratory score is 0.
    • If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
    • If the infant cries well, the respiratory score is 2.

    Heart rate is evaluated by stethoscope. This is the most important assessment:

    • If there is no heartbeat, the infant scores 0 for heart rate.
    • If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
    • If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

    Muscle tone:

    • If muscles are loose and floppy, the infant scores 0 for muscle tone.
    • If there is some muscle tone, the infant scores 1.
    • If there is active motion, the infant scores 2 for muscle tone.

    Grimace response or reflex irritability is a term describing response to stimulation, such as a mild pinch:

    • If there is no reaction, the infant scores 0 for reflex irritability.
    • If there is grimacing, the infant scores 1 for reflex irritability.
    • If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

    Skin color:

    • If the skin color is pale blue, the infant scores 0 for color.
    • If the body is pink and the extremities are blue, the infant scores 1 for color.
    • If the entire body is pink, the infant scores 2 for color.

    Why the Test is Performed

    This test is done to determine whether a newborn needs help breathing or is having heart trouble.

    Normal Results

    The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.

    A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet, which is normal for after birth.

    What Abnormal Results Mean

    Any score lower than 7 is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother’s womb.

    Most of the time a low Apgar score is caused by:

    • Difficult birth
    • C-section
    • Fluid in the baby’s airway

    A baby with a low Apgar score may need:

    • Oxygen and clearing out the airway to help with breathing
    • Physical stimulation to get the heart beating at a healthy rate

    Most of the time, a low score at 1 minute is near-normal by 5 minutes.

    A lower Apgar score does not mean a child will have serious or long-term health problems. The Apgar score is not designed to predict the future health of the child.

    Alternative Names

    Newborn scoring


    The five criteria of the Apgar score:

     Score of 0Score of 1Score of 2Component of acronym
    Complexionblue or pale all overblue at extremities
    body pink
    no cyanosis
    body and extremities pink
    Pulse rateabsent< 100 beats per minute> 100 beats per minutePulse
    Reflex irritability grimaceno response to stimulationgrimace on suction or aggressive stimulationcry on stimulationGrimace
    Activitynonesome flexionflexed arms and legs that resist extensionActivity
    Respiratory effortabsentweak, irregular, gaspingstrong, lusty cryRespiration

    Interpretation of scores

    Mind map showing summary for the Apgar score

    The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 7 and above are generally normal, 4 to 6 fairly low, and 3 and below are generally regarded as critically low.

    A low score on the one-minute test may show that the neonate requires medical attention[3] but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times—such as 10, 15, or 30 minutes—may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test’s purpose is to determine quickly whether a newborn needs immediate medical care. It is not designed to predict long term health issues.[1]

    A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant average difference in the first Apgar score, but not the second. Oxygen saturation (see Pulse oximetry) also was lower at high altitude.[4]


    Some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

    Spanish: Apariencia, Pulso, Gesticulación, Actividad, Respiración;

    Portuguese: Aparência, Pulso, Gesticulação, Atividade, Respiração;

    French: Apparence, Pouls, Grimace, Activité, Respiration;

    German: Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order (respiration, pulse, muscle tone, appearance, reflex).

    Another eponymous backronym from Virginia Apgar’s name is American Pediatric Gross Assessment Record.

    Another mnemonic for the test is “How Ready IThis Child?” — which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.


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