Apgar Score (Newborn)

Scores newborn condition at 1 and 5 minutes using the five Apgar signs (Appearance, Pulse, Grimace, Activity, Respiration), each scored 0–2 for a total of 0–10 (Apgar 1953). Higher scores indicate better transition to extrauterine life.

Pediatrics PediatricsEvidence-BasedUpdated 2026-08-16

Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.

Clinical Notes

The Apgar score is a rapid, standardized assessment of newborn condition introduced by Virginia Apgar in 1953. It evaluates five signs — Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (breathing effort) — each scored 0, 1, or 2 for a total of 0–10. Scoring is performed at 1 minute and 5 minutes after birth. If the 5-minute score is below 7, continue scoring every 5 minutes up to 20 minutes. The 1-minute score reflects the need for immediate intervention; the 5-minute score assesses the response to resuscitation and the adequacy of the transition to extrauterine life. A score of 7–10 is considered reassuring and indicates a newborn who is transitioning well. A score of 4–6 indicates moderate depression and may require stimulation, warmth, airway positioning, and close reassessment. A score of 0–3 indicates severe depression and the need for immediate, active resuscitation. Critical limitations: The AAP and ACOG (2015) emphasize that the Apgar score should be reported but should not be used alone to drive resuscitation decisions — respirations, heart rate, and color guide resuscitation. Low scores may occur in preterm infants, infants whose mothers received sedation, or those with congenital anomalies, without implying birth asphyxia. The score has inter-observer variability and is a snapshot of clinical status, not a diagnostic test. It should not be used to predict long-term neurologic outcomes.

Calculator Information

Specialty

Pediatrics

📋 Reference Ranges

Normal Range

7–10 reassuring; 4–6 moderately depressed; 0–3 severely depressed. Scores are recorded at 1 and 5 minutes and every 5 minutes thereafter until 20 minutes if the 5-minute score is below 7.

Reference ranges for this calculator
Classification	Range
Reassuring At 1 and 5 minutes	7–10
Moderately depressed May require stimulation and observation	4–6
Severely depressed Requires immediate resuscitation	0–3

What This Calculator Measures

Scores newborn condition immediately after birth using the five Apgar signs — Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — each scored 0–2 for a total of 0–10 (Apgar 1953).

How to Use

Assign a value of 0, 1, or 2 to each of the five signs at the moment of scoring, using a timer.
Score at 1 minute and 5 minutes of life; repeat every 5 minutes up to 20 minutes if the 5-minute score is below 7.
Sum the five components (0–10) and review the severity band.

How the Calculation Works

The Apgar score sums five components each scored 0-2: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (respiratory effort), for a total of 0-10.

Variables Explained

Appearance (Skin Color)

Skin color, scored 0 (pale/blue), 1 (acrocyanotic), or 2 (completely pink).

Pulse (Heart Rate)

Heart rate, scored 0 (absent), 1 (below 100 bpm), or 2 (100 bpm or above).

Grimace (Reflex Irritability)

Reflex response to stimulation, scored 0 (no response), 1 (grimace), or 2 (cry or active withdrawal).

Activity (Muscle Tone)

Muscle tone, scored 0 (limp), 1 (some flexion), or 2 (active motion).

Respiration (Respiratory Effort)

Respiratory effort, scored 0 (apneic), 1 (slow or irregular), or 2 (good, crying).

Interpretation Guide

Scores of 7–10 are reassuring; 4–6 indicate moderate depression of the newborn; 0–3 indicate severe depression requiring immediate resuscitation. Per AAP/AHA guidance, the score is used to report the newborn's condition and response to resuscitation, not alone to decide whether resuscitation is needed.

Age-specific interpretation

Clinical Significance

The Apgar score provides a rapid, standardized, universally used snapshot of a newborn's immediate condition and response to resuscitation, facilitating communication between delivery-room teams and guiding the intensity of ongoing observation.

When It Is Useful

Standard assessment of every newborn at 1 and 5 minutes of life
Reporting the response to neonatal resuscitation
Documentation of newborn transition in the delivery room

When It Is Not Useful

As the sole trigger for resuscitation decisions (respirations, heart rate, and color guide resuscitation)
As a predictor of long-term neurologic outcome

Common Mistakes

Waiting for the 1-minute score before starting resuscitation instead of responding to the newborn's breathing, pulse, and color.
Stopping after the delivery-room score and omitting the 5-minute assessment even though the first score was below 7.
Treating a low score in a preterm or sedated infant as proof of birth asphyxia when the score is only a snapshot of condition.

Limitations

Scores are lower in preterm, sedated, or congenitally abnormal infants without implying asphyxia.
Inter-observer variability exists among scorers.
The score is a crude index of transition, not a diagnostic test.

Worked Example

A term infant at 1 minute is pink all over, heart rate 130 bpm, grimaces to stimulation, has some flexion of extremities, and has a vigorous cry.

Inputs:

appearance: 2

pulse: 2

grimace: 1

activity: 2

respiration: 2

Expected Result: Apgar score 9/10 — reassuring; continue routine newborn care and reassess at 5 minutes.

Evidence & References

Source:: Obstetrics / Neonatology
Content updated:: 2026-08

Apgar V. Curr Res Anesth Analg. 1953;32(4):260-267.
AAP/ACOG Committee. The Apgar score. Pediatrics. 2015;136(4):819-822.

References

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267. (Original Description)
AAP Committee on Fetus and Newborn, ACOG Committee on Obstetric Practice. The Apgar score. Pediatrics. 2015;136(4):819-822. (Guideline)

Frequently Asked Questions

What does an Apgar score mean?

7-10: reassuring. 4-6: moderate depression, may need stimulation. 0-3: severe depression, immediate resuscitation required. The score assesses heart rate, respiration, muscle tone, reflex irritability, and color.

When is the Apgar score assessed?

At 1 minute and 5 minutes after birth. If the 5-minute score is less than 7, continue scoring every 5 minutes up to 20 minutes. The score reports the newborn condition and response to resuscitation.

Can Apgar predict long-term outcomes?

No. Apgar is a snapshot of transition at birth. Low scores in preterm or sedated infants do not imply asphyxia. It should not be used to predict long-term neurologic outcomes.

Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The Apgar score is a reporting tool; resuscitation decisions should be guided by the newborn's respirations, heart rate, and color.