How the APGAR score works

The APGAR score is a quick and easy measurement of a newborn’s response to birth and life outside the womb — specifically, the fetal-to-neonatal transition.

The baby is assessed on five simple criteria (complexion, pulse rate, reaction when stimulated, muscle tone, and breathing) on a scale from zero to two. The five values are then summed up to obtain a score from zero to 10.
How does your baby score? From 0 to 10

Newborn Sidney Jacob, moments after entering the worldRatings are based on the following five factors:

A: Appearance (color)

0 for blue or pale all over
1 for pink with blue extremities
2 for pink overall

P: Pulse (heartbeat)

0 for absent (no pulse)
1 for under 100 bpm
2 for over 100 bpm

G: Grimace (reflex)

0 for non-responsive
1 for grimace with suction or strong stimulation
2 for cough, sneeze or cry with stimulation

A: Activity (muscle tone)

0 for limp
1 for some reflex
2 for active movement

R: Respiration (breathing)

0 for absent
1 for slow, irregular breaths (weak, irregular, gasping)
2 for good, strong cry

Tallying up the totals

As you can see, for each factor, there is a score of 0 (poorest), 1 or 2 (best) which may be given. The score is taken at one and five minutes (sometimes also 10 minutes) after birth, the total high score being 10 and the lowest score a zero. Scores of 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 is considered generally normal.

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According to a Norwegian study reported in the British Medical Journal in 2010, a low Apgar score was strongly associated with later diagnosis of cerebral palsy. The prevalence of cerebral palsy in children with Apgar score of less than 3 was more than 100-fold higher than in children with a score of 10. This association was high in children with normal birth weight and modest in children with low birth weight. Low Apgar score was also associated with all subgroups of spastic cerebral palsy, but the association was strongest for quadriplegia.



In an accompanying editorial, Professor Nigel Paneth from Michigan State University in the US says that a low Apgar score in a baby of normal weight “is an important clue that the baby has an increased risk of death and disability, even though most infants with such scores recover quickly and do well.”

Useful for birth – not for kindergarten

The American Academy of Pediatrics made a statement in 1996 regarding the use and abuse of the scoring system as anything other than a newborn assessment tool, noting, “Apgar scores are useful in assessing the condition of the infant at birth. Their use in other settings, such as collection of a child’s Apgar score at entry to school, is inappropriate.”

This scale was named for its creator, pediatrician Virginia Apgar (1909-1974), who introduced the system in 1952. Since she created the ‘backronym’ with her name, it is perhaps fortunate her name was not more along the lines of Virginia Keihanaikukauakahihuliheekahaunaele (considered one of the longest surnames in America).

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