Apgar score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


The Apgar score was devised in 1952 by Dr. Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth.[1][2] Virginia Apgar was a pediatrician and anesthesiologist who developed the score to ascertain the effects of anaesthetic agents on neonates.

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 were used as a mnemonic learning aid.


Score of 0 Score of 1 Score of 2 Component of Acronym
Skin color blue all over blue at extremities
body pink
no blue cyanosis
body and extremities pink
Heart rate absent <100 >100 Pulse
Reflex irritability no response to stimulation grimace/feeble cry when stimulated sneeze/cough/pulls away when stimulated Grimace
Muscle tone none some flexion active movement Activity
Breathing absent weak or irregular strong Respiration
The five criteria of the Apgar score:

Interpretation of scores

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 below 3 are generally regarded as critically low, 4 to 6 fairly low, and over 7 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 was not designed to make long-term predictions on a child's health.

Contrary to popular opinion the APGAR score is no longer used to decide if a neonate requires resuscitation. That decision is based on emergency assessment of airway, breathing, and circulation ("ABC").


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 same acronym is used in German (Atmung, Puls, Grundtonus, Aussehen, Reflexe), Spanish (Apariencia, Pulso, Gesticulación, Actividad, Respiración) and French (Apparence, Pouls, Grimace, Activité et Respiration) although the letters have different meanings.

Another such backformation attempting to make Apgar an acronym is American Pediatric Gross Assessment Record. The test, however, is named for Dr. Apgar, making Apgar an eponymous backronym.

The test has also been reformulated with a different mnemonic, How Ready Is This Child, but the criteria are essentially the same: Heart rate, Respiratory effort, Irritabililty, Tone, and Colour.

See also


  1. Apgar, Virginia (1953). "A proposal for a new method of evaluation of the newborn infant". Curr. Res. Anesth. Analg. 32 (4): 260–267. PMID 13083014. 
  2. Finster M (2005). "The Apgar score has survived the test of time". Anesthesiology. 102 (4): 855–857. PMID 15791116. 
  3. Casey BM (February 15, 2001). "The continuing value of the Apgar score for the assessment of newborn infants". N Engl J Med. 344 (7): 467–471. PMID 11172187. 

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