Apgar score

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Virginia Apgar, creator of the Apgar score

The Apgar score is a method to quickly summarize the health of newborn children against infant mortality.[1][2] Virginia Apgar, an anesthesiologist at NewYork–Presbyterian Hospital, developed the score in 1952 to quantify the effects of obstetric anesthesia on babies.

The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. The five criteria are summarized using words chosen to form a backronym (Appearance, Pulse, Grimace, Activity, Respiration).


The five criteria of the Apgar score:
Score of 0 Score of 1 Score of 2 Component of backronym
Skin color blue or pale all over blue at extremities,
body pink
no cyanosis
body and extremities pink
Pulse rate absent < 100 beats per minute > 100 beats per minute Pulse
Reflex irritability grimace no response to stimulation grimace on suction or aggressive stimulation cry on stimulation Grimace
Activity none some flexion flexed arms and legs that resist extension Activity
Respiratory effort absent weak, irregular, gasping strong, robust cry Respiration

Interpretation of scores[edit]

Mind map showing summary for the Apgar score

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 7 and above are generally normal; 4 to 6, fairly low; and 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts.[3]

A low score on the one-minute test may show that the neonate requires medical attention[4] but does not necessarily indicate a long-term problem, particularly if the score improves at the five-minute test. An Apgar score that remains below 3 at later times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy. However, the Apgar test's purpose is to determine quickly whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues.[1]

A score of 10 is uncommon, due to the prevalence of transient cyanosis, and does not substantially differ from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at very high altitude (4340 m or 14,138 ft) found a significant average difference in the first Apgar score but not the second. Oxygen saturation (see pulse oximetry) also was lower at high altitude.[5]


Some ten years after initial publication,[citation needed] a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration.

  • Spanish: Apariencia, Pulso, Gesticulación, Actividad, Respiración;
  • Portuguese: Aparência, Pulso, Gesticulação, Atividade, Respiração;
  • French: Apparence, Pouls, Grimace, Activité, Respiration;
  • German: Atmung, Puls, Grundtonus, Aussehen, Reflexe, representing the same tests but in a different order (respiration, pulse, muscle tone, appearance, reflex).

Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record.

Another mnemonic for the test is “How Ready Is This Child?”, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color.[6]

See also[edit]


  1. ^ a b Apgar, Virginia (1953). "A proposal for a new method of evaluation of the newborn infant" (PDF). Curr. Res. Anesth. Analg. 32 (4): 260–267. doi:10.1213/00000539-195301000-00041. PMID 13083014.
  2. ^ Finster, M.; Wood, M. (May 2005). "The Apgar score has survived the test of time". Anesthesiology. 102 (4): 855–857. doi:10.1097/00000542-200504000-00022. PMID 15791116.
  3. ^ Holton, Tim. "What Are APGAR Scores, And Why Are They Important?". www.holtonlaw.com.
  4. ^ Casey, B. M.; McIntire, D. D.; Leveno, K. J. (February 15, 2001). "The continuing value of the Apgar score for the assessment of newborn infants". N Engl J Med. 344 (7): 467–471. doi:10.1056/NEJM200102153440701. PMID 11172187.
  5. ^ Gonzales, G. F.; Salirrosas, A. (2005). "Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m)". Reproductive Biology and Endocrinology : RB&E. 3: 46. doi:10.1186/1477-7827-3-46. PMC 1215518. PMID 16156890.
  6. ^ J. M. Klostranec, J. Hong, K. Raghuran. 2012. The Essential Med Notes for Medical Students 2012. University of Toronto Press, Toronto, ON.

Further reading[edit]

External links[edit]