1. APGAR Scoring for Newborns
A score is given for each sign at one minute and five minutes after the birth.
If there are problems with the baby an additional score is given at 10
minutes. A score of 7-10 is considered normal, while 4-7 might require some
resuscitative measures, and a baby with apgars of 3 and below requires
immediate resuscitation.
Sign 0 Points 1 Point 2 Points
A
Activity
(Muscle
Tone)
Absent
Arms and
Legs Flexed
Active
Movement
P Pulse Absent
Below 100
bpm
Above 100
bpm
G
Grimace
(Reflex
Irritability)
No
Response Grimace
Sneeze,
cough, pulls
away
A
Appearance
(Skin Color)
Blue-gray,
pale all
over
Pink all
over except
for
extremities
Normal over
entire body
R Respiration Absent
Slow,
irregular,
weak cry
Good, crying
How is the Apgar score done?
The Apgar score is a number calculated by scoring the heart rate, respiratory
effort, muscle tone, skin color, and reflex irritability (response to

2. a catheter in the nostril). Each of these objective signs can receive 0, 1, or 2
points.
What does a high or low Apgar score mean?
A perfect Apgar score of 10 means an infant is in the best possible condition.
An infant with an Apgar score of 0-3 needs immediate resuscitation. It is
important to note that diligent care of the newborn is an immediate
response to the current status of the infant. It is inappropriate to wait until
Apgar scores are obtained to begin or continue to address the needs of the
neonate.
When is the Apgar scoring done?
The Apgar score is done routinely 60 seconds after the birth of the infant
and then is repeated five minutes after birth.
In the event of a difficult resuscitation, the Apgar score may be done again
at 10, 15, and 20 minutes.
What does a persistently low Apgar score mean?
The persistence of low (0-3) Apgar scores at 20 minutes of age is predictive
of high rates of morbidity (disease) and mortality (death).
Why was the Apgar score developed?
The score is named for the preeminent American anesthesiologist Dr.
Virginia Apgar (1909-1974), who invented the scoring method in 1952.
Having assisted at thousands of deliveries, Dr. Apgar wished to focus
attention on the baby. Babies were traditionally dispatched directly to the
nursery, often without much formal scrutiny after delivery. Apgar wanted the
baby to be assessed in an organized meaningful manner by the delivery-
room personnel. Dr. Apgar was the first woman to be appointed a full
professor at Columbia University's College of Physicians and Surgeons.