The Apgar score (Apgar V., Curr Res Anesth Analg 1953) is the standard tool for the initial assessment of a newborn's condition. It includes 5 signs: Appearance (skin color), Pulse (heart rate), Grimace (reflex response to stimulation), Activity (muscle tone), and Respiration (breathing). Each sign is scored 0-2 points, for a total of 0-10.
It is assessed at 1 and 5 minutes of life (with additional assessments at 10, 15, and 20 minutes if scores are low). Interpretation: 8-10 is normal; 4-7 indicates a moderately depressed condition requiring observation and additional support; 0-3 indicates a severely depressed condition requiring active resuscitation.
The scale is used worldwide and is part of the standard delivery protocol and neonatal care guidelines. Important caveat: a low Apgar score does not automatically mean perinatal asphyxia or future neurologic sequelae. It is a tool for rapid assessment at the moment of birth, not a diagnosis.
When to use
Birth of any newborn: mandatory assessment at 1 and 5 minutes.
For scores < 7: additional assessment at 10, 15, and 20 minutes.
Documentation of the initial condition in the delivery record.
Triage in the neonatal intensive care unit.
Parameters in detail
Skin color (Appearance)
Skin color: 0 - cyanotic/pale all over, 1 - pink body with blue extremities (acrocyanosis), 2 - pink all over.
Heart rate (Pulse)
Heart rate: 0 - absent, 1 - < 100/min, 2 - ≥ 100/min. Assessed by auscultation or palpation of the umbilical cord.
Reflexes (Grimace)
Reflex response to stimulation (nasal catheter): 0 - no response, 1 - grimace/weak response, 2 - active response (cough, sneeze, cry).
Muscle tone (Activity)
Muscle tone: 0 - limp, 1 - some flexion of extremities, 2 - active movement with flexed extremities.
Full-term newborn, 38 weeks. One minute after birth: acrocyanosis, heart rate 90/min, grimace in response to catheter, weak tone, irregular breathing with a weak cry.
Apgar 5 at 1 minute indicates a moderately depressed condition. Management: warming, tactile stimulation (rubbing the back, tapping the soles), and if there is no improvement, positive-pressure ventilation via face mask with FiO2 21-30% (target SpO2 by age in minutes). Reassess at 5 minutes; if the score remains low, continue resuscitation per protocol. In parallel, obtain umbilical cord blood for pH assessment (perinatal asphyxia workup).
Limitations and cautions
Not a diagnosis of perinatal asphyxia, which requires umbilical cord pH < 7.0, base deficit ≥ 12, and clinical HIE.
In preterm infants, low scores may reflect immaturity rather than distress.
Skin color assessment is subjective and varies across skin tones.
Breathing cannot be assessed in newborns on mechanical ventilation; adapted modifications are used instead.
Frequently asked questions
How does the 1-minute score differ from the 5-minute score?
The 1-minute score reflects the condition immediately after birth and the effectiveness of initial resuscitation measures. The 5-minute score reflects the response to those measures and has greater prognostic value.
What should be done for an Apgar of 5-7 at 5 minutes?
Continue active resuscitation support until stabilization, transfer to an observation unit, assess acid-base status, and monitor.
Is the Apgar score linked to cerebral palsy?
An isolated low Apgar score does not predict cerebral palsy. A correlation only emerges when combined with HIE criteria (umbilical cord pH, neurologic signs, neuroimaging).
Is it used in preterm infants?
It is used, but interpretation requires caution. In extremely preterm infants (< 28 weeks), low tone and weak breathing are often due to immaturity rather than asphyxia.
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Aleksandr A. Aulov
Physician, internal medicine, Sechenov School — independent medical education platform.
Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.
This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.
Last clinical review: April 28, 2026 ·
Author: Aleksandr A. Aulov,
MD, internal medicine ·
Primary source: Apgar V. Anesth Analg 1953; 32: 260-267