Apgar V. 1953. Public Domain

APGAR Score Calculator

Neonatal assessment at 1 and 5 minutes. Score five components (Appearance, Pulse, Grimace, Activity, Respiration) each 0–2 for a total of 0–10.

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Scoring at 1 minute. Assesses transition from intrauterine to extrauterine life.

Score Each Component (0–2)

A
Appearance (Skin Color)
P
Pulse (Heart Rate)
G
Grimace (Reflex Irritability)
A
Activity (Muscle Tone)
R
Respiration (Breathing Effort)
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Frequently Asked Questions About the APGAR Score

APGAR is a mnemonic for the five components: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort). It was developed by Dr. Virginia Apgar, an anesthesiologist at Columbia University, and first described in 1953. The acronym was created later to make the components easier to remember.

The APGAR score is routinely assessed at 1 minute and 5 minutes after birth. The 1-minute APGAR reflects the neonate's response to the birthing process and the need for immediate resuscitation. The 5-minute APGAR reflects the effectiveness of any resuscitative efforts and the baby's adaptation to extrauterine life. If the 5-minute score is <7, additional APGAR scores are obtained at 10, 15, and 20 minutes.

Each of the five components is scored 0, 1, or 2, giving a total of 0–10:

  • 7–10 (Normal): Good transition. Most newborns score 7–9 at 1 minute; a perfect 10 is uncommon due to acrocyanosis (blue extremities).
  • 4–6 (Moderately Depressed): The baby requires some stimulation or assistance. Supplemental oxygen, positive pressure ventilation, or other support may be needed.
  • 0–3 (Severely Depressed): Immediate resuscitation is required. This typically means cardiac compressions, ventilation, or emergency medications.

The APGAR score was designed to guide immediate neonatal resuscitation, not to predict long-term neurological outcomes. A low 1-minute APGAR score does not reliably predict long-term developmental outcomes. The 5-minute score has some correlation with neonatal mortality and neurological morbidity, but is not a reliable predictor of individual neurodevelopmental outcomes. Per the AAP/ACOG Committee Opinion (2015), the APGAR score should not be used alone to diagnose hypoxic-ischemic encephalopathy or to predict neurologic outcome.

Several factors unrelated to asphyxia can lower the APGAR score, including prematurity (preterm infants have lower tone and may have depressed reflexes), maternal analgesics or sedatives, congenital neuromuscular disorders, infection, and maternal magnesium therapy. Inter-observer variability in scoring is also a recognized limitation. The APGAR score should always be interpreted in the clinical context.