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APGAR Score (Newborn Assessment)

The APGAR score rates a newborn at 1 and 5 minutes on appearance, pulse, grimace, activity and respiration (0–2 each, total 0–10). A score of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.

  • Appearance (skin 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 to stimulation (0); Grimace on stimulation (1); Cry or active withdrawal (2)
  • Activity (muscle tone): Limp (0); Some flexion (1); Active motion (2)
  • Respiration: Absent (0); Weak, irregular or gasping (1); Good, crying (2)
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Interpretation

ResultMeaning
7–10Reassuring
4–6Moderately abnormal
0–3Low

Formula

Sum of Appearance + Pulse + Grimace + Activity + Respiration, each 0–2 (total 0–10). Score at 1 and 5 min; if 5-min score < 7, repeat every 5 min up to 20 min.

Clinical pearls

  • Resuscitation must not be delayed to assign the 1-minute APGAR; NRP decisions are based on heart rate, breathing and tone.
  • A low APGAR alone does not establish asphyxia or predict individual neurologic outcome.
  • Prematurity, maternal sedation and congenital anomalies lower the score independent of hypoxia.

Examples

apgar acrocyanosis, hr over 100, grimace, some flexion, weak cryapgar score: pink, pulse 140, crying, active, good crynewborn limp, blue, hr 80, no response, gasping apgar

FAQ

What is a normal APGAR score?

A score of 7 to 10 is reassuring. Most healthy newborns score 7–9 at 1 minute because hands and feet are often still blue.

When is the APGAR score done?

At 1 and 5 minutes after birth, and every 5 minutes up to 20 minutes if the 5-minute score is below 7.

Evidence

  1. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953;32:260–7.
  2. AAP Committee on Fetus and Newborn; ACOG Committee on Obstetric Practice. The Apgar Score. Pediatrics 2015;136:819–22.

Pediatrics & Obstetrics · Reviewed 2026-10-14 · Methodology