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APGAR Score
Five observations, each worth 0, 1 or 2, taken at one minute and again at five. It is a shared shorthand for how a newborn looked and how they responded, and it takes seconds once you know the rows. What it is not, is a prediction, and the modern guidance is firmer about that than most people were taught.
Skip to the testThe five components
| Component | 0 | 1 | 2 |
|---|---|---|---|
| AppearanceSkin colour | Blue or pale all over | Pink body, blue hands and feet (acrocyanosis) | Pink all over |
| PulseHeart rate | Absent | Under 100 bpm | 100 bpm or above |
| GrimaceReflex irritability to stimulation | No response | Grimace or weak cry | Cry, cough, sneeze, or pulls away |
| ActivityMuscle tone | Limp | Some flexion of the limbs | Active motion, limbs flexed and resisting |
| RespirationBreathing effort | Absent | Slow or irregular, weak cry | Good strong cry, regular breathing |
Score at 1 minute and 5 minutes. If the 5-minute score is under 7, continue scoring every 5 minutes up to 20 minutes. A perfect 10 is less common than people expect, because acrocyanosis alone holds Appearance at 1 in a great many completely healthy newborns.
What the score is not for
Three things the joint AAP and ACOG policy rules out
- It does not predict an individual baby’s mortality or neurological outcome, and it has been misused in exactly that way.
- It is not on its own a diagnosis of asphyxia or of oxygen deprivation.
- It does not decide whether, when, or how to resuscitate. Those decisions come from the immediate assessment of breathing, heart rate and tone, long before the 1-minute score exists.
The expanded Apgar form exists because the bare number hides too much. It records the interventions running at the same time as the score, so oxygen, positive pressure ventilation, intubation, compressions and adrenaline sit beside it. A 6 on room air and a 6 on full ventilatory support describe very different babies.
Prematurity complicates it further: immature tone and reflexes depress the Activity and Grimace rows regardless of how well the infant is doing, so a preterm score reads lower without meaning what it would in a term baby.
Is it still used?
Yes. It remains the standard way of reporting a newborn’s status at 1 and 5 minutes, and Alberta’s own public health information describes it as routine practice. What changed is not whether it is recorded, but what may be concluded from it: the score reports status and response to resuscitation, and stops there.
Test yourself
Ready to test yourself?
10 randomized questions drawn from a bank of 14, with an explanation after every answer. No score is kept or sent anywhere, so take it as many times as you like.
A free study aid from Delta Emergency Support Training. Not certification and not medical direction. Newborn resuscitation is governed by your own protocols, training and medical oversight. Content checked against the joint AAP/ACOG policy statement on the Apgar score.