APGAR Score Calculator

Rapidly assess newborn condition at 1 and 5 minutes after birth using the APGAR scoring system. This standardised assessment helps guide immediate postnatal care and resuscitation decisions.

Important Clinical Disclaimer: The APGAR score assessment is intended for use by qualified healthcare professionals only. It is for educational and informational purposes and should not replace clinical judgement. Always interpret results alongside the full clinical picture and follow your local guidelines and protocols.
APGAR Assessment
Select the time point for this assessment

Response to stimulation (e.g., nasal suctioning, tactile stimulation)

APGAR Mnemonic

The APGAR score is named after Dr Virginia Apgar, but also serves as a helpful mnemonic:

  • Appearance (skin colour)
  • Pulse (heart rate)
  • Grimace (reflex irritability)
  • Activity (muscle tone)
  • Respiration (breathing effort)
About the APGAR Score

The APGAR score was developed by Dr Virginia Apgar in 1952 as a rapid method to assess newborn condition and need for resuscitation. It remains the standard assessment used worldwide.

When to Assess:
  • 1 minute - Initial assessment
  • 5 minutes - Reassessment (most predictive)
  • 10+ minutes - If score remains <7

Important: The APGAR score should not delay resuscitation - assessment and intervention occur simultaneously.

APGAR Score Interpretation

Score Category Interpretation & Action
7-10 Reassuring
  • Normal transition to extrauterine life
  • Routine postnatal care
  • Skin-to-skin contact and early feeding encouraged
  • Continue routine observation
4-6 Moderately Depressed
  • May require some resuscitative measures
  • Stimulation, airway positioning, suction if needed
  • Supplemental oxygen may be required
  • Close monitoring and reassessment at 5 minutes
0-3 Severely Depressed
  • Requires immediate resuscitation
  • Positive pressure ventilation
  • May need chest compressions and/or medications
  • Summon additional help (neonatal team)
  • Reassess every 5 minutes during resuscitation
Important:

The APGAR score should not be used to determine whether to initiate resuscitation or to guide resuscitation decisions in real-time. Resuscitation should be based on assessment of heart rate, respiratory effort, and colour, and should not be delayed to calculate an APGAR score.

APGAR Scoring Criteria

Parameter 0 1 2
Appearance
Skin colour		 Blue/pale all over Acrocyanosis
(pink body, blue extremities)		 Completely pink
Pulse
Heart rate		 Absent < 100 bpm ≥ 100 bpm
Grimace
Reflex irritability		 No response Grimace/feeble cry Cry, cough, sneeze
Activity
Muscle tone		 Limp/flaccid Some flexion Active movement
Respiration
Breathing effort		 Absent Weak/irregular Good/crying

Limitations

Limitations of the APGAR Score
  • Subjective assessment - interobserver variability exists
  • Affected by gestational age - preterm infants normally have lower tone and reflexes
  • Affected by medications - maternal sedation, anaesthesia
  • Affected by congenital anomalies - neuromuscular conditions, cardiac defects
  • Not predictive of long-term outcome - a single low score does not predict neurological outcome
  • Skin colour assessment - less reliable in non-white infants
Significance of Different Time Points
1-Minute Score

Reflects immediate condition and need for resuscitation. May be low in many healthy infants who are still transitioning.

5-Minute Score

More predictive of outcome. A persistently low 5-minute score (<7) warrants continued intervention and monitoring.

10-Minute and Beyond

Recorded if 5-minute score is <7. A score of 0 at 10 minutes is associated with high mortality and morbidity, though not universally so.

Frequently Asked Questions

Virginia Apgar (1909-1974) was an American obstetric anaesthesiologist who developed the APGAR score in 1952. She was the first woman to be a full professor at Columbia University College of Physicians and Surgeons.

Her scoring system revolutionised neonatal care by providing a simple, rapid method to assess newborn condition and guide intervention. The score was originally presented at a meeting in 1952 and published in 1953.

A score of 7-10 is considered normal and reassuring. Most healthy newborns score 7-9 at 1 minute and 8-10 at 5 minutes.

  • A perfect score of 10 is relatively uncommon at 1 minute, as many healthy babies have some acrocyanosis initially
  • The 5-minute score is generally higher as the baby transitions to extrauterine life
  • A score of 7+ at 5 minutes is reassuring for good outcome

No single low APGAR score is predictive of cerebral palsy or long-term neurological outcome.

  • Most infants with low 1-minute scores recover fully
  • A persistently low score (0-3) at 10, 15, and 20 minutes is associated with increased risk of adverse outcomes
  • However, the majority of children with cerebral palsy had normal APGAR scores at birth
  • The APGAR score should not be used to establish the diagnosis of asphyxia or to predict outcome in medicolegal contexts

Preterm infants typically have lower APGAR scores due to developmental immaturity:

  • Tone (Activity) - normally reduced in preterm infants
  • Reflex irritability (Grimace) - less developed
  • Respiratory effort - may require support even when healthy
  • Colour - more likely to be cyanotic initially

The score should be interpreted in the context of gestational age. A preterm infant with a lower score may be doing well for their developmental stage.

Absolutely not. The APGAR score is a retrospective assessment, not a real-time guide to resuscitation.

  • Resuscitation should begin immediately based on clinical assessment (breathing, heart rate, colour)
  • The APGAR score is assigned at specific time points but should not delay intervention
  • Heart rate is the most important indicator guiding resuscitation decisions

Modern neonatal resuscitation follows algorithms based on heart rate and respiratory effort, not APGAR score.

Disclaimer

This calculator is provided for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

  • Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.
  • Never disregard professional medical advice or delay seeking it because of information from this tool.
  • Clinical decision-making should always incorporate the full clinical context, patient preferences, and local protocols.
  • The creators of this tool accept no liability for decisions made based on its output.

If you are a patient: please discuss any results with your healthcare provider. This tool is designed for use by medical professionals and may not be appropriate for self-assessment.

References

  1. Apgar V. (1953). A proposal for a new method of evaluation of the newborn infant. Current Researches in Anesthesia and Analgesia, 32(4), 260-267.
  2. American Academy of Pediatrics Committee on Fetus and Newborn. (2015). The Apgar Score. Pediatrics, 136(4), 819-822.
  3. Resuscitation Council UK. (2021). Newborn Resuscitation and Support of Transition of Infants at Birth Guidelines.
  4. NICE. (2021). Neonatal infection: antibiotics for prevention and treatment (NG194).
  5. Casey BM, et al. (2001). The continuing value of the Apgar score for the assessment of newborn infants. New England Journal of Medicine, 344(7), 467-471.