Apgar score
The Apgar score assesses the newborn’s vitality at 1 and 5 minutes of life from five signs: heart rate, respiratory effort, muscle tone, reflex irritability and skin color. Score each sign and the calculator shows the total and the interpretation at each time point.
Score the five signs at 1 and 5 minutes of life. Each sign scores 0 to 2; the total ranges from 0 to 10 at each time point.
1 minute
5 minutes
The Apgar score does not decide when to start resuscitation: it assesses the newborn's response to the interventions. If the score is below 7 at 5 minutes, repeat every 5 minutes up to 20 minutes of life (expanded Apgar) and document it alongside the procedures performed.
Clinical decision-support tool for use by healthcare professionals. It does not replace clinical judgment or your unit's protocols.
How to score
Each sign receives 0, 1 or 2 points, for a total of 0 to 10. A score of 7 to 10 indicates good vitality; 4 to 6, moderate asphyxia; 0 to 3, severe asphyxia.
What the Apgar does not do
The Apgar score does not decide when to start resuscitation: interventions begin within the first 30 seconds based on breathing and heart rate. The score documents the newborn’s response. If it is below 7 at 5 minutes, repeat every 5 minutes up to 20 minutes of life (expanded Apgar), recording the interventions under way.
Example
At 1 minute: heart rate above 100 (2), irregular breathing (1), some flexion (1), grimace on stimulation (1), cyanosis of the extremities (1). Apgar 6, moderate asphyxia. At 5 minutes: heart rate above 100 (2), strong cry (2), active movement (2), cry on stimulation (2), cyanosis of the extremities (1). Apgar 9, good vitality.
Frequently asked questions
Does a low 1-minute Apgar mean neurologic injury?
No. The 1-minute Apgar reflects the immediate transition and has low prognostic value on its own. The 5-minute score and its trend, together with blood gases and the neurologic examination, inform prognosis better.
Should I wait for the Apgar before starting resuscitation?
No. The decision to resuscitate is made within the first 30 seconds based on breathing and heart rate, before the first minute.
What is the expanded Apgar?
It is repeating the score every 5 minutes, up to 20 minutes of life, when the 5-minute Apgar is below 7, always recording the resuscitation interventions under way.
References
- 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):819-22.
- Brazilian Society of Pediatrics (SBP). Neonatal Resuscitation Program. Resuscitation of the newborn ≥ 34 weeks in the delivery room: 2026 guidelines.
- Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-7.
