APGAR Newborn Score Calculator
The APGAR score, introduced by anaesthesiologist Virginia Apgar in 1952, is the global bedside standard for newborn assessment. At 1 and 5 minutes after birth (and again at 10/15/20 minutes if the initial scores are low), the midwife, nurse or clinician scores five signs — Appearance (skin colour), Pulse, Grimace (reflex irritability), Activity (muscle tone) and Respiration — with 0–2 points each. This tool sums them instantly (0–10) and bands the total per the AAP / ACOG convention: 0–3 severely depressed, 4–6 moderately depressed, 7–10 reassuring — useful for documentation, teaching and delivery-room triage.
Pick a score (0–2) for each of the five signs.
APGAR total
10 / 10
Reassuring
A2 P2 G2 A2 R2
Clinical band (AAP / ACOG convention)
0–3 Moderately depressed
4–6 Reassuring
7–10
Original scale: Virginia Apgar, Curr Res Anesth Analg 1953. For clinical reference only — not a substitute for medical judgement.
Formula
APGAR = A (Appearance) + P (Pulse) + G (Grimace) + A (Activity) + R (Respiration); each 0–2, total 0–10 Band (AAP / ACOG): 0–3 severely depressed, 4–6 moderately depressed, 7–10 reassuring
- · Original scale: Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953;32(4):260-7.
- · Appearance (skin colour): 2 completely pink, 1 body pink with peripheral cyanosis (acrocyanosis), 0 pale or cyanotic all over.
- · Pulse (auscultation or umbilical cord palpation): 2 ≥ 100 bpm, 1 < 100 bpm, 0 absent.
- · Grimace / reflex irritability (suction or sole stimulation): 2 cough/sneeze/cry, 1 grimace, 0 no response.
- · Activity / muscle tone: 2 active motion, 1 some flexion, 0 limp.
- · Respiration: 2 strong regular cry, 1 weak/irregular/gasping, 0 absent.
- · Timing: by convention scored at 1 and 5 minutes; if the 5-minute score is < 7, repeat every 5 minutes through 20 minutes (AAP/ACOG joint statement, 2015 reaffirmed).
- · A low APGAR alone does not diagnose perinatal asphyxia or hypoxic-ischaemic encephalopathy — that requires umbilical-artery pH, base deficit and neurological assessment. Resuscitation decisions should follow the Neonatal Resuscitation Program (NRP) algorithm and clinician judgement.
Frequently asked
Does a low APGAR mean the baby is in trouble — and does it mandate brain imaging?
No. The AAP and ACOG have repeatedly stated that a single APGAR score — including the 5-minute score — cannot diagnose perinatal asphyxia or hypoxic-ischaemic encephalopathy (HIE), nor predict long-term neurological outcome (AAP/ACOG Policy Statement, Pediatrics 2015;136:819-822). Many infants with a 5-minute score < 7 turn out completely normal; low scores can also be driven by prematurity (lower baseline tone), maternal anaesthesia, sedation, infection, congenital heart disease or placental issues. Diagnosing asphyxia or HIE additionally requires umbilical-artery pH ≤ 7.0 or base deficit ≥ 12 mmol/L, a 5-minute APGAR ≤ 5, abnormal neurological exam, and multi-organ involvement (Sarnat staging). Imaging (cranial ultrasound / MRI) and therapeutic hypothermia are considered only if low scores persist at 10 minutes alongside these other criteria.
How do you score APGAR in preterm, caesarean-delivered or intubated newborns?
The scale itself is unchanged, but interpretation differs. Preterm infants have lower baseline muscle tone (Activity) and respiratory effort at birth, so a low APGAR can reflect immaturity rather than hypoxia. NRP 8th edition (2021) recommends documenting both the "actual" APGAR and the resuscitation support being provided (oxygen, PPV, CPAP, intubation, chest compressions, medications) — the so-called "expanded" or "combined" APGAR. Caesarean-delivered babies score on average ~0.3–0.5 points lower at 1 minute than vaginal-birth peers, but the 5-minute score usually catches up. For intubated infants, Respiration and Grimace are inferred from chest rise, response to manual ventilation and clinical reactivity; record "on PPV" or "intubated" alongside the score so subsequent clinicians can interpret it correctly.
Why has APGAR barely changed in 70 years — are there modern alternatives?
APGAR has endured because it is simple, reproducible and entirely bedside — five signs, no equipment, usable anywhere. The known weaknesses are well documented: limited interpretation in preterm and intubated infants, substantial inter-rater variability and modest prediction of long-term outcomes. Proposed complements and alternatives include CRIB / CRIB-II (preterm illness severity, requires blood gases and congenital anomaly grading), SNAP / SNAPPE-II (physiologic data from the first 12 hours) and the "Specified / Combined / Expanded APGAR" framework (Rüdiger et al., 2015) that documents the score alongside the resuscitation provided. Even so, AAP and ACOG continue to recommend the classic APGAR as the standard score, interpreted together with umbilical-cord gases, resuscitation records and neurological assessment.
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