What is a normal APGAR score?

A score of 7–10 at 1 minute is considered reassuring. Scores of 4–6 may require some resuscitative measures, and scores of 0–3 require immediate resuscitation. The 5-minute APGAR score is more predictive of neonatal outcomes than the 1-minute score.

What are the limitations of the APGAR score?

The APGAR score is subjective and can be affected by gestational age, maternal medications, congenital anomalies, and interrater variability. A low APGAR score alone does not diagnose birth asphyxia. The American Academy of Pediatrics states that APGAR scores should not be used to predict individual neurologic outcome.

When should additional APGAR scores be recorded?

Beyond the standard 1- and 5-minute scores, additional APGAR scores should be recorded every 5 minutes (at 10, 15, and 20 minutes) if the 5-minute score is less than 7, until the score reaches 7 or 20 minutes has elapsed.

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APGAR Score

Rapid assessment of neonatal well-being at 1 and 5 minutes after birth. Five components scored 0–2 each for a total of 0–10.

Eingaben

Appearance (skin color)

Pulse (heart rate)

Grimace (reflex irritability)

Activity (muscle tone)

Respiration

APGAR Score (0–10)

Severely depressed

Interpretation—

Action—

Disclaimer: For educational purposes only. The APGAR score does not guide resuscitation decisions — initiate NRP (Neonatal Resuscitation Program) steps based on clinical assessment, not score.

Bewertung

Appearance (skin color): 0–2
Pulse (heart rate): 0–2
Grimace (reflex irritability): 0–2
Activity (muscle tone): 0–2
Respiration: 0–2

Interpretation

7–10: Reassuring — routine newborn care
4–6: Moderately depressed — may need stimulation/airway management
0–3: Severely depressed — immediate resuscitation needed

Clinical pearls

Score at 1 minute reflects immediate condition; 5 minutes assesses response to resuscitation.
If 5-minute score < 7, reassess every 5 minutes up to 20 minutes.
APGAR does not predict long-term neurologic outcome and should not be used in isolation.
Preterm infants may have lower baseline scores; interpret in context of gestational age.
Do not delay resuscitation to calculate the APGAR score.

References

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260–267.
AAP/AHA. Neonatal Resuscitation Program (NRP), 8th edition, 2021.

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Über dieses Tool

What Is the APGAR Score?

The APGAR score, introduced by Dr. Virginia Apgar in 1953, is the most universally used system for rapid assessment of neonatal status immediately after birth. It evaluates five clinical signs — Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — each scored 0–2 for a total of 0–10. The score is assessed at 1 minute and 5 minutes of life, with additional assessments every 5 minutes if the 5-minute score is below 7.

When to Use the APGAR Score

The APGAR score should be assigned to every newborn at 1 and 5 minutes after complete delivery. The 1-minute score reflects the infant's immediate condition and tolerance of the birth process. The 5-minute score is more predictive of neonatal outcomes and indicates response to any resuscitative interventions. Importantly, resuscitation should never be delayed to calculate an APGAR score — initiate NRP steps based on clinical assessment.

Interpreting APGAR Results

Scores of 7–10 are reassuring and indicate a vigorous newborn requiring routine care. Scores of 4–6 suggest moderate depression requiring stimulation and potentially airway management. Scores of 0–3 indicate severe depression requiring immediate resuscitation per NRP guidelines. A 5-minute APGAR <7 warrants continued monitoring and reassessment at 10, 15, and 20 minutes.

🔑 Klinische Hinweise

The APGAR score was never designed to predict long-term neurological outcome. A low 1-minute score that normalizes by 5 minutes is generally reassuring.
Preterm infants often have lower baseline APGAR scores due to immature tone, reflexes, and respiratory effort — interpret in the context of gestational age.
The "Appearance" component is unreliable in non-white infants, as acrocyanosis assessment depends on skin pigmentation. Assess perfusion using capillary refill time and pulse oximetry as adjuncts.
An APGAR of 0 at 10 minutes, despite adequate resuscitation, is associated with very high mortality and severe morbidity — it is often a factor in discussions about discontinuing resuscitation efforts.

Schlüsselreferenzen

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260–267.
AAP Committee on Fetus and Newborn. The APGAR score. Pediatrics. 2015;136(4):819–822.
Weiner GM (ed). Textbook of Neonatal Resuscitation (NRP), 8th edition. American Academy of Pediatrics, 2021.

Formel zuletzt überprüft: Februar 2026