APGAR Score
Rapid assessment of newborn clinical status at birth
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Why use it
Universal standard for newborn assessment. Quick bedside tool to determine need for resuscitation. Tracks response to resuscitation interventions. Part of every delivery documentation.
About
The APGAR score provides a standardized assessment of newborn status at 1 and 5 minutes after birth. It evaluates five components: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. It guides the need for immediate resuscitative interventions.
When to use
- Every delivery at 1 and 5 minutes of life
- Extended scoring at 10, 15, 20 minutes if score remains < 7
- Assessment of resuscitation response
Formula
Pearls & pitfalls
- APGAR is an assessment tool, NOT an indication for resuscitation — NRP algorithms guide actual interventions.
- Low 1-minute APGAR prompts intervention; 5-minute score is more predictive of outcomes.
- Score < 7 at 5 minutes: continue scoring every 5 minutes up to 20 minutes.
- APGAR does not predict long-term neurological outcome when used in isolation.
- Premature infants tend to have lower scores without necessarily being "sicker".
- Named as both an acronym AND after Dr. Virginia Apgar.
Next steps
Score 7-10: Normal, routine care. Score 4-6: Some resuscitation needed (stimulation, O2, PPV). Score 0-3: Aggressive resuscitation (intubation, chest compressions, medications).
Evidence
Published by Virginia Apgar in 1953. Universally adopted worldwide. Validated as a rapid clinical assessment tool. Low 5-minute APGAR associated with increased neonatal mortality, but poor predictor of long-term CP or developmental outcome.