1Formula & method
The APGAR score provides a standardized assessment of neonatal wellbeing at birth.
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (Colour) | Blue/pale | Blue extremities | Completely pink |
| Pulse (Heart Rate) | Absent | <100 bpm | ≥100 bpm |
| Grimace (Reflex) | No response | Grimace/weak cry | Sneeze/cough/cry |
| Activity (Muscle Tone) | Limp/flaccid | Some flexion | Active motion |
| Respiration | Absent | Weak/gasping | Strong cry |
2How to interpret results
Score Interpretation
- 7–10: Normal. Routine post-delivery care.
- 4–6: Moderate depression. Stimulate, dry, warm, supplemental O₂. Consider PPV.
- 0–3: Severe depression. Immediate resuscitation (PPV, chest compressions).
3NRP 2020 Resuscitation Highlights
All newborns: Warm, dry, stimulate, position airway. Assess: Is the baby term? Breathing/crying? Good muscle tone? If yes — routine care. If no — begin resuscitation.
Positive Pressure Ventilation (PPV): Indicated if gasping, apneic, or HR <100 bpm. Rate: 40–60 breaths/min. Start at 21% O₂ for term babies.
Chest Compressions: Indicated if HR <60 bpm despite 30 seconds of effective PPV. Ratio: 3:1 (90 compressions + 30 ventilations per minute).
4Frequently asked questions
What does each Apgar component assess?
Appearance (skin colour): 0=blue/pale all over, 1=blue extremities body pink, 2=completely pink. Pulse: 0=absent, 1=<100, 2=≥100 bpm. Grimace (reflex): 0=none, 1=grimace, 2=cry/cough/sneeze. Activity (tone): 0=limp, 1=some flexion, 2=active motion. Respiration: 0=absent, 1=weak/irregular, 2=strong cry.
What Apgar score requires immediate resuscitation?
Score 7–10: normal, routine care. Score 4–6: moderate depression — stimulation, supplemental O2, consider PPV. Score 0–3: severely depressed — immediate resuscitation: warmth, airway, PPV, if HR <60 despite PPV then chest compressions (3:1 ratio), then IV/IO adrenaline 0.01 mg/kg if HR still <60.
When exactly is Apgar score assessed?
At 1 minute and 5 minutes after birth. The 1-minute score guides immediate resuscitation. The 5-minute score reflects response to resuscitation and predicts outcome better. If 5-minute score <7, repeat at 10, 15, and 20 minutes until ≥7 on two consecutive assessments.
Does low Apgar predict long-term outcome?
A low 1-minute score alone does not reliably predict long-term outcome — many resuscitate well and develop normally. A persistently low 5-minute score (<3) is associated with higher risk of cerebral palsy and neurodevelopmental delay but is not diagnostic. Apgar is a resuscitation guide, not a neurological prognosis tool.
What is the Apgar score in preterm infants?
Standard Apgar is less reliable in preterm infants where low tone, colour, and respiratory effort are expected physiologically. The Expanded Apgar score includes gestational age context. NRP now emphasises HR, respiratory effort, and tone as primary resuscitation triggers rather than Apgar total score alone.
What causes a low Apgar score?
Intrapartum asphyxia (most common), prematurity, maternal sedation (opioids, magnesium toxicity), congenital anomalies (diaphragmatic hernia, CHD), infection (chorioamnionitis, early-onset sepsis), and neuromuscular conditions. In India, prolonged obstructed labour and home deliveries without skilled attendance are important preventable causes.
Medical disclaimer: This calculator is for educational and clinical decision-support purposes only. It does not replace clinical judgment or specialist consultation. RxMedCalc is not liable for clinical decisions made solely on this tool.