APGAR Score Calculator

The five components

Virginia Apgar devised the score in 1952 as a rapid structured assessment of a newborn's condition. Five signs, each scored 0, 1 or 2, giving a total from 0 to 10.

Appearance covers colour: 0 for blue or pale throughout, 1 for pink body with blue extremities, 2 for pink throughout. Pulse: 0 for absent, 1 for under 100, 2 for 100 or above.

Grimace is reflex irritability on stimulation. Activity is muscle tone. Respiration is respiratory effort and cry. The backronym using Apgar's own surname was devised later as a teaching aid and has outlasted the memory of who she was.

When it is scored

The score is assigned at one minute and five minutes after birth. If the five minute score is below 7, it is repeated every five minutes up to twenty.

The one minute score reflects the transition from intrauterine to extrauterine life and correlates poorly with outcome. The five minute score carries considerably more prognostic weight.

Importantly, resuscitation is never delayed to assign a score. Assessment of breathing, heart rate and tone drives immediate management, and the Apgar score documents the condition rather than directing the response.

Interpreting the total

A score of 7 to 10 is reassuring. Four to 6 is moderately abnormal and generally prompts intervention. Zero to 3 is low and indicates the need for immediate resuscitation.

The great majority of healthy newborns score 8 or 9 at one minute, since fully pink extremities are uncommon that early. A score of 10 is unusual rather than a target.

The American Academy of Pediatrics and American College of Obstetricians and Gynecologists have both stated explicitly that the score alone does not predict individual neurological outcome and should not be used to diagnose asphyxia, which it has historically been misused for in medicolegal contexts.

Where the score is affected by other things

Prematurity lowers scores independently of any problem, because tone and respiratory effort are immature. A preterm infant can score low and be doing as well as expected for gestational age.

Maternal sedation, magnesium sulphate and opioid analgesia all depress the newborn's tone and respiratory effort.

Congenital anomalies, neuromuscular conditions and infection all affect it. Which means a low score prompts a search for a cause rather than an assumption about one.

What this page is for

It adds five numbers. Assigning those numbers is a clinical assessment performed at a birth by someone trained to do it, in the seconds and minutes when other things are also happening.

The score is documented in the notes and it forms part of a much larger picture including cord gases, the clinical course and any resuscitation given.

This is a reference for the components and their scoring, useful for revision or for checking a total. It has no role at an actual delivery, where the people present will not be consulting a website.

It is worth knowing where the score sits alongside the other information gathered at a difficult birth. Umbilical cord blood gases, taken from both artery and vein, provide an objective measure of the fetal acid-base state at delivery, and they are what actually indicate whether significant hypoxia occurred. A low Apgar score with normal cord gases and a low score with a severe metabolic acidosis describe very different situations, and the combination is far more informative than either alone.