APGAR Score Calculator

About the APGAR Score Calculator

The Apgar score is a quick check of a newborn baby’s condition at 1 minute and 5 minutes after birth. Five signs — Appearance (skin colour), Pulse (heart rate), Grimace (reflex response), Activity (muscle tone) and Respiration (breathing) — each score 0, 1 or 2, for a total of 0 to 10. If the 5-minute score is below 7, the score is taken again every 5 minutes up to 20 minutes.

Score the signs yourself (for students and clinicians, with the optional record of resuscitation that the expanded Apgar adds), or type the totals you were told, such as “Apgar 8 and 9” on discharge papers. You get each score’s band — 7–10 reassuring, 4–6 moderately abnormal, 0–3 low — and what the score does and does not tell you. It is not used to decide whether a baby needs resuscitation, and it does not predict an individual baby’s future.

Without a pass, the free preview shows the latest Apgar score in full, with its band and what it means; the earlier scores and the copy for notes come with a Pro pass.

Common uses

• Understanding the Apgar scores on a baby’s birth record or discharge papers.
• Practising Apgar scoring as a midwifery, nursing or medical student.
• Recording 1-, 5- and later-minute scores with the resuscitation given, for the expanded Apgar.

The five signs

• Appearance (colour): 0 blue or pale all over · 1 body pink, hands and feet blue (acrocyanosis) · 2 pink all over.
• Pulse (heart rate): 0 no heartbeat · 1 below 100 beats a minute · 2 100 or more beats a minute.
• Grimace (reflex irritability): 0 no response to stimulation · 1 grimace · 2 cry or active withdrawal.
• Activity (muscle tone): 0 limp · 1 some flexion of arms and legs · 2 active movement.
• Respiration (breathing effort): 0 not breathing · 1 weak cry, slow or irregular breathing · 2 good breathing, crying.

The traditional wording for colour, “completely pink”, does not describe every skin tone well (one paper suggests “flesh-toned” instead): the sign is whether the baby is blue or pale.

What the score means

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists describe a score of 7 to 10 as reassuring, 4 to 6 as moderately abnormal and 0 to 3 as low, for babies born at term or late preterm. The bands are described for the 5-minute score and the later ones. A low 1-minute score is usually near normal by 5 minutes, and a full 10 is unusual because almost every newborn loses a point for blue hands and feet.

The same organisations stress the limits:

• The Apgar score is not used to decide whether to start resuscitation: the birth team acts on breathing and heart rate straight away, before the 1-minute score.
• A score given during resuscitation is not equivalent to one given to a baby breathing on its own, so the expanded Apgar records the help given (oxygen, CPAP, mask ventilation, intubation, chest compressions, adrenaline).
• On its own it is not evidence of a lack of oxygen at birth and does not predict an individual baby’s survival or neurological outcome.
• It depends partly on maturity, so babies born early tend to score lower.

Sources

• Apgar V, A proposal for a new method of evaluation of the newborn infant, Current Researches in Anesthesia & Analgesia.
• American Academy of Pediatrics Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice, The Apgar score, Pediatrics (also ACOG Committee Opinion No. 644).
• The criteria table: Ehrenstein V, Association of Apgar scores with death and neurologic disability, Clinical Epidemiology.
• Bands, later scores and the resuscitation rule as summarised in Tantu T et al., Prevalence and factors associated with low 5th minute APGAR score, BMC Pregnancy and Childbirth.
• The expanded Apgar’s interventions: Rüdiger M et al., Neonatal assessment in the delivery room — Trial to Evaluate a Specified Type of Apgar (TEST-Apgar), BMC Pediatrics.
• Colour and skin tone, and the original names of the signs: Jackson RL, The Apgar score and race: why healthy babies are supposed to be “pink”, History and Philosophy of the Life Sciences.
• MedlinePlus (US National Library of Medicine), Apgar score.

Limitations

• For understanding and recording only: a baby’s care at birth is decided by the birth team’s assessment, never by this page.
• The bands were described for babies born at term or late preterm; babies born very early often score lower because of immaturity.
• Several signs (colour especially) are judged by eye, so two observers can give slightly different scores.

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