Sign 0 points 1 point 2 points

Activity
A limp limbs flexed active movement
(Muscle tone)
Pulse
P absent < 100 /min > 100 /min
(heart rate)
cough or sneeze
Grimace (nose)
G (response to smell or foot absent grimace cry and
slap) withdrawal of
foot (foot slap)
Appearance body pink
A blue pink all over
(color) extremities blue
Respiration irregular
R absent good st
(breathing) weak crying

The test is generally done at one and five minutes after birth, and may be
repeated later if the score is and remains low. Scores 3 and below are
generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally
normal.
A low score on the one-minute test may show that the neonate requires
medical attention[3] but is not necessarily an indication that there will be
long-term problems, particularly if there is an improvement by the stage of
the five-minute test. If the Apgar score remains below 3 at later times such
as 10, 15, or 30 minutes, there is a risk that the child will suffer longer-
term neurological damage. There is also a small but significant increase of
the risk of cerebral palsy. However, the purpose of the Apgar test is to
determine quickly whether a newborn needs immediate medical care; it
wasnot designed to make long-term predictions on a child's health.[1]
A score of 10 is uncommon due to the prevalence of transient cyanosis,
and is not substantially different from a score of 9. Transient cyanosis is
common, particularly in babies born at high altitude. A study comparing
babies born in Peru near sea level with babies born at very high altitude
(4340 m) found a significant difference in the first but not the second Apgar
score. Oxygen saturation (see Pulse oximetry) also was lower at high
altitude.[4]
A score is given for each sign at one minute and five minutes after the birth. If
there are problems with the baby an additional score is given at 10 minutes. A
score of 7-10 is considered normal, while 4-7 might require some resuscitative
measures, and a baby with apgars of 3 and below requires immediate
resuscitation.

Sign 0 Points 1 Point 2 Points

Activity (Muscle
A Tone)
Absent Arms and Legs Flexed Active Movement
P Pulse Absent Below 100 bpm Above 100 bpm
Grimace (Reflex Sneeze, cough, pulls
G Irritability)
No Response Grimace
away
Appearance (Skin Blue-gray, pale all Normal, except for Normal over entire
A Color) over extremities body
R Respiration Absent Slow, irregular Good, crying

About the Apgar Score

The very first test given to your newborn, the Apgar score occurs right
after your baby's birth in the delivery or birthing room. The test was
designed to quickly evaluate a newborn's physical condition after
delivery and to determine any immediate need for extra medical or
emergency care.
Although the Apgar score was developed in 1952 by an
anesthesiologist named Virginia Apgar, you may have also heard it
referred to as an acronym for: Activity, Pulse, Grimace,Appearance,
and Respiration.

The Apgar test is usually given to your baby twice: once at 1 minute
after birth, and again at 5 minutes after birth. Rarely, if there are
concerns about the baby's condition and the first two scores are low,
the test may be scored for a third time at 10 minutes after birth.

Five factors are used to evaluate the baby's condition and each factor
is scored on a scale of 0 to 2, with 2 being the best score:

1. activity and muscle tone

2. pulse (heart rate)
 3. grimace response (medically known as "reflex irritability")
4. appearance (skin coloration)
5. respiration (breathing rate and effort)
Doctors, midwives, or nurses add these five factors together to
calculate the Apgar score. Scores obtainable are between 10 and 0,
with 10 being the highest possible score.
Apgar Scoring

Apgar Sign 2 1 0

Heart Rate Normal (above Below 100 Absent

(pulse) 100 beats per beats per (no pulse)
minute) minute

Breathing Normal rate Slow or Absent (no

(rate and effort) and effort, irregular breathing)
good cry breathing,
weak cry

Grimace(responsiveness Pulls away, Facial Absent (no

or "reflex irritability") sneezes, or movement response to
coughs with only stimulation)
stimulation (grimace)
with
stimulation

Activity Active, Arms and legs No movement,

(muscle tone) spontaneous flexed with "floppy" tone
movement little
movement

Appearance Normal color all Normal color Bluish-gray or

(skin coloration) over (hands (but hands pale all over
and feet are and feet are
pink) bluish)

What Apgar Scores Mean

A baby who scores a 7 or above on the test at 1 minute after birth is
generally considered in good health. However, a lower score doesn't
necessarily mean that your baby is unhealthy or abnormal. But it may
mean that your baby simply needs some special immediate care, such
as suctioning of the airways or oxygen to help him or her breathe,
after which your baby may improve.

At 5 minutes after birth, the Apgar score is recalculated, and if your

baby's score hasn't improved to 7 or greater, or there are other
concerns, the doctors and nurses may continue any necessary medical
care and will closely monitor your baby. Some babies are born with
heart or lung conditions or other problems that require extra medical
care; others just take a little longer than usual to adjust to life outside
the womb. Most newborns with initial Apgar scores of less than 7 will
eventually do just fine.

It's important for new parents to keep their baby's Apgar score in
perspective. The test was designed to help health care providers
assess a newborn's overall physical condition so that they could
quickly determine whether the baby needed immediate medical care.
It was not designed to predict a baby's long-term health, behavior,
intellectual status, or outcome. Few babies score a perfect 10, and
perfectly healthy babies sometimes have a lower-than-usual score,
especially in the first few minutes after birth.
Keep in mind that a slightly low Apgar score (especially at 1 minute) is
normal for some newborns, especially those born after a high-risk
pregnancy, cesarean section, or a complicated labor and delivery.
Lower Apgar scores are also seen in premature babies, who usually
have less muscle tone than full-term newborns and who, in many
cases, will require extra monitoring and breathing assistance because
of their immature lungs.

If your doctor or midwife is concerned about your baby's score, he or

she will let you know and will explain how your baby is doing, what
might be causing problems, if any, and what care is being given. For
the most part, though, most babies do very well, so relax and enjoy
the moment!
The Apgar score is determined by evaluating the newborn baby on five
simple criteria on a scale from zero to two and summing up the five values
thus obtained. The resulting Apgar score ranges from zero to 10.
The five criteria of the Apgar score
Score 0 Score 1 Score 2
Heart rate absent <100 >100
Respiration absent weak or irregular strong
Muscle tone none some flexion active movement
no response grimace/feeble cry sneeze/cough/pulls away
Reflex irritability
to stimulation when stimulated when stimulated
Skin color blue all over blue at extremities normal

The test is generally done at 1 and 5 minutes after birth, and may be
repeated later if the score is, and remains, low. Scores below 3 are
generally regarded as critically low, with 4 – 7 fairly low and over 7
generally normal.
Low scores at the one minute test may require medical attention, but are
not an indication of longer term problems, particularly if there is an
improvement by the stage of the five minute test. If the Apgar score
remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk
that the child will suffer longer term neurological damage. There is also a
small but significant increase in the risk ofcerebral palsy. However, the
purpose of the Apgar test is to determine quickly whether a newborn needs
immediate medical care; it wasnot designed to make long–term predictions
on a child's health.
Some ten years after the initial publication, the acronym APGAR was
coined in the US as a mnemonic learning aid: Appearance (skin
color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone),
and Respiration. The mnemonic was introduced in 1963 by
the pediatrician Dr. Joseph Butterfield. The acronym also exists in German
(Atmung, Puls, Grundtonus, Aussehen, Reflexe) although here the letters
have different meanings.