Evaluates the clinical status of the new born infant based on the five neonatology vital signs to check whether medical attention is required.

The text below the tool provides more information on the criteria used and instructions on how to interpret the score.

The APGAR score checks the five neonatology clinical signs soon after birth in order to ensure the new born infant receives adequate medical care if needed.

The five criteria are:

■ Activity/Muscle Tone;

■ Pulse/Heart rate stethoscope evaluation;

■ Grimace/Reflex irritability;

■ Appearance/Skin color;

■ Respiration/Breathing effort.

The recommendation is that the score is assessed 1 minute and 5 minutes after birth. APGAR scores vary between 0 and 10, 10 being indicative of the best condition in all 5 criteria.

Any score of 7 and above is considered normal whilst scores below 7 mean that the new born infant requires assistance such as suction, warming or supplemental oxygen.

Most commonly, the score in the first assessment is lower than that of the second evaluation.


Activity/Muscle Tone


Pulse/Heart rate stethoscope evaluation


Grimace/Reflex irritability


Appearance/Skin color


Respiration/Breathing effort

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APGAR score

The score evaluates the new-born’s condition at 1 minute and 5 minutes after birth based on five criteria, pertaining to physical condition, as presented in the table below:

APGAR criteria Evaluation choices (points awarded)
Activity/Muscle Tone Active motion (2)
Some muscle tone and extremity flexion (1)
Loose and floppy muscles (0)
Pulse/Heart rate stethoscope evaluation Equal or higher than 100 bpm (2)
Lower than 100 bpm (1)
Absent (0)
Grimace/Reflex irritability Sneeze, cough or vigorous cry present (2)
Grimace present (1)
No reaction (0)
Appearance/Skin color Entire body pink (2)
Pink body, blue extremities (1)
Pale blue (0)
Respiration/Breathing effort Good effort, crying infant (2)
Slow and or irregular (1)
Not breathing (0)

The score is twice performed by one of the medical professionals being present at delivery.

The first evaluation focuses on how well the new-born tolerated the birth process whilst the second evaluation, after 5 minutes from birth, focuses on how well the infant has accommodated outside of the womb.


APGAR interpretation

The score ranges between 0 and 10, where 10 indicates that the infant is in the best physical condition and has scored highest in all five criteria. Perfect 10 scores are quite rare because, often, the new born still has the extremities bluish and may receive only 1 point out of the 2 for skin appearance.

In most cases, the 5 minutes assessment is higher than the 1 minute assessment.

Scores of 7 and above are considered normal. Scores below 7 indicate that the new born may require intervention to help with adapting outside the womb. In such cases, suction, warming or supplemental oxygen may take place.

Low scores occur in case of a difficult birth, if the infant’s airways are blocked by fluid or in C-sections.

Some frequent misconceptions around the APGAR score include the belief that the score has predictability in regard to the future health of the baby or that it predicts personality or intellect. These are all false, as the score only looks at physical condition at the time when is administered.


About the creator

The world renowned score was introduced back in 1953 by Dr Virginia Apgar, thus the acronym comes both from her name and the initials of the five criteria: Appearance, Pulse, Grimace, Activity and Respiration.

Virginia Apgar MD, was an obstetrical anesthesiologist and the first to create a score to be administered at time of birth.  She was also the first woman to be named Full Professor at Columbia University’s College of Physicians and Surgeons.


Original source

Apgar V. (1953) A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953; 32(4):260-7.

Other references

1. Apgar V. (1966) The newborn (Apgar) scoring system. Reflections and advice. Pediatr Clin North Am. 1966; 13(3):645-50.

2. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001; 344(7):467-71.

Specialty: Neonatology

Objective: Evaluation

Type: Score

No. Of Items: 5

Year Of Study: 1953

Abbreviation: APGAR

Article By: Denise Nedea

Published On: March 16, 2017

Last Checked: March 16, 2017

Next Review: March 10, 2023