What the Apgar score tells you
The Apgar score is the newborn assessment that anesthesiologist Virginia Apgar devised in 1952 and published in 1953. It records five signs quickly to show how well a baby is adapting to life outside the womb. Her paper says she chose signs that could be checked easily without getting in the way of the baby's care.
The joint statement of the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), issued in 2015 and reaffirmed by ACOG in 2025, describes the score as a way to report a newborn's status right after birth and the response to resuscitation. The same statement says the score alone cannot diagnose asphyxia or predict an individual baby's mortality or neurologic outcome, and should not be used for that.
The five signs (A-P-G-A-R)
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (color) | Blue or pale | Acrocyanotic | Completely pink |
| Pulse (heart rate) | Absent | Below 100/min | 100/min or more |
| Grimace (reflex irritability) | No response | Grimace | Cry or active withdrawal |
| Activity (muscle tone) | Limp | Some flexion | Active motion |
| Respiration | Absent | Weak cry, hypoventilation | Good, crying |
The level wording follows the AAP table as reproduced in OpenStax Fundamentals of Nursing. A-P-G-A-R is a memory aid; Apgar's paper lists the signs as heart rate, respiratory effort, reflex irritability, muscle tone and color. She gave 2 points for a heart rate of 100 to 140 and 1 point for under 100, so this calculator treats exactly 100 per minute as 2 points.
Total and what the 5-minute score means
Total = color + heart rate + reflex irritability + muscle tone + respiration (0-2 each, 0-10 overall)
| 5-minute score | Band |
|---|---|
| 7-10 | Reassuring |
| 4-6 | Moderately abnormal |
| 0-3 | Low |
- The AAP and ACOG take these bands from the report Neonatal Encephalopathy and Neurologic Outcome (2014), and they apply to the 5-minute score. The calculator shows the same bands at 1 minute only as a guide.
- Apgar's 1953 paper grouped 1-minute scores as 8-10 good, 3-7 fair and 0-2 poor. Those cut points differ from today's 5-minute bands, so keep them apart.
- A score of 0-3 at 5 minutes or later is a nonspecific sign of illness that may be one of the first signs of encephalopathy, but a persistently low score alone does not show intrapartum compromise.
When to score and when to repeat
Every baby is scored at 1 and 5 minutes. If the 5-minute score is below 7, the Neonatal Resuscitation Program (NRP) guidelines call for repeat scores every 5 minutes up to 20 minutes. The calculator keeps separate 1, 5, 10, 15 and 20-minute slots and tells you which slot to fill next while the score stays below 7.
The AAP and ACOG note that the 5-minute score, and the change between 1 and 5 minutes, is a useful index of the response to resuscitation. When both are filled in, the calculator shows the change.
Why it is not used to decide on resuscitation
- A baby who needs resuscitation needs it before the 1-minute score is assigned. The AAP and ACOG therefore state that the Apgar score is not used to decide whether resuscitation is needed, which steps to take or when to use them.
- A score assigned during resuscitation is not the same as one assigned to a baby breathing on their own. The AAP and ACOG encourage an expanded Apgar reporting form that records the resuscitation under way alongside each score. This calculator does not record interventions, so use your unit's form for real charting.
Limits to keep in mind
- Maternal sedation or anesthesia, congenital anomalies, gestational age, trauma and differences between observers all affect the score.
- Tone, color and reflex irritability are partly subjective and depend on maturity. A healthy preterm baby can score low because of immaturity alone.
- Oxygen saturation is normally low in the first minutes. The NRP targets are 60-65% at 1 minute and 80-85% at 5 minutes, so a low color score need not prompt oxygen straight away, the AAP and ACOG explain.
Worked examples
| Time and scores | Total | Band |
|---|---|---|
| 1 min: 1 · 2 · 1 · 1 · 1 | 6 | Guide only: moderately abnormal |
| 5 min: 1 · 2 · 2 · 2 · 2 | 9 | Reassuring |
| 5 min: 1 · 1 · 1 · 1 · 1 | 5 | Moderately abnormal, score again at 10 min |
"Load example" fills in the first two rows. A baby with blue hands and feet, a heart rate over 100, only a grimace to suction, slightly flexed limbs and a weak cry scores 6 at 1 minute. If only the blue hands and feet remain at 5 minutes, the score is 9, up 3 points. Blue hands and feet often last a few minutes; Apgar noted that few babies earned 2 points for color at 1 minute.
Sources
- Apgar V. A proposal for a new method of evaluation of the newborn infant. Current Researches in Anesthesia & Analgesia 1953;32(4):260-267. Record. Reprinted in Anesthesia & Analgesia 2015;120(5):1056-1059, full text. The five signs, scoring at 60 seconds, 1-minute groups.
- American Academy of Pediatrics Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar Score. Pediatrics 2015;136(4):819-822. Full text. 5-minute bands, repeat scores to 20 minutes, not for resuscitation decisions, limits and the expanded form.
- ACOG Committee Opinion No. 644: The Apgar Score (2015, reaffirmed 2025). ACOG. ACOG's version of the same statement and its reaffirmation year.
- OpenStax. Fundamentals of Nursing, 39.1 Growth and Development Stages. Full text. Level wording from the AAP table.
Frequently asked questions
How is the Apgar score calculated?
Score color, heart rate, reflex irritability, muscle tone and respiration as 0, 1 or 2 each and add them. The total runs from 0 to 10; higher means a better condition right after birth.
When is it assigned?
At 1 and 5 minutes after birth for every baby. If the 5-minute score is below 7, it is repeated every 5 minutes up to 20 minutes (AAP and ACOG, 2015).
What is a normal Apgar score?
The AAP and ACOG describe a 5-minute score of 7-10 as reassuring, 4-6 as moderately abnormal and 0-3 as low in term and late-preterm infants.
Is the Apgar score used to decide on resuscitation?
No. Resuscitation has to start before the 1-minute score is assigned, so the AAP and ACOG state that the score is not used to decide whether resuscitation is needed, which steps to take or when.
Does a low score mean brain injury?
No. The score alone cannot diagnose asphyxia or predict an individual baby's mortality or neurologic outcome. Maternal sedation or anesthesia, congenital anomalies and gestational age can all lower it.
Is it scored the same way in preterm babies?
The method is the same, but a healthy preterm baby can score low because of immaturity alone. The 7-10, 4-6 and 0-3 bands were defined for term and late-preterm infants.