The Apgar score is a scoring system doctors and nurses use to assess newborns after they’re born. A score of 7 to 10 five minutes after birth is reassuring, 4 to 7 is moderately abnormal, and 0 to 3 is concerning.
Dr. Virginia Apgar created the Apgar scoring system in 1952. She used her name as a mnemonic for each of the five categories that a person will score. Since that time, medical professionals across the world have used her scoring system to assess newborns in their first moments of life.
Medical professionals use this assessment to quickly relay the status of a newborn’s overall condition. Low Apgar scores may indicate the baby needs special care, such as extra help with their breathing.
Sometimes after birth, a nurse or doctor may announce the Apgar scores to the labor room. This lets all present medical personnel know how a baby is doing, even if some of the medical personnel are tending to the mom.
When a parent hears these numbers, they should know they’re one of many different assessments medical providers will use.
Other examples include heart rate monitoring and umbilical artery blood gases. However, assigning an Apgar score is a quick way to help others understand the baby’s condition immediately after birth.
The Apgar scoring system is divided into five categories. Each category receives a score of 0 to 2 points. At most, a child will receive an overall score of 10. However, a baby rarely scores a 10 in the first few moments of life. This is because most babies have blue hands or feet immediately after birth.
A: Activity/muscle tone
- 0 points: limp or floppy
- 1 point: limbs flexed
- 2 points: active movement
P: Pulse/heart rate
- 0 points: absent
- 1 point: less than 100 beats per minute
- 2 points: greater than 100 beats per minute
G: Grimace (response to stimulation, such as suctioning the baby’s nose)
- 0 points: absent
- 1 point: facial movement/grimace with stimulation
- 2 points: cough or sneeze, cry and withdrawal of foot with stimulation
A: Appearance (color)
- 0 points: blue, bluish-gray, or pale all over
- 1 point: body pink but extremities blue
- 2 points: pink all over
- 0 points: absent
- 1 point: irregular, weak crying
- 2 points: good, strong cry
The Apgar scores are recorded at one and five minutes. This is because if a baby’s scores are low at one minute, a medical staff will likely intervene, or increased interventions already started.
At five minutes, the baby has ideally improved. If the score is very low after five minutes, the medical staff may reassess the score after 10 minutes. Doctors expect that some babies may have lower Apgar scores. These include:
- premature babies
- babies born via cesarean delivery
- babies who had complicated deliveries
A score of 0 to 3 is concerning. It indicates a need for increased intervention, usually in assistance for breathing. A parent may see nurses drying off a child vigorously or delivering oxygen via a mask.
Sometimes a doctor, midwife, or nurse practitioner may recommend transferring a patient to a neonatal intensive care nursery for further assistance.
The Apgar score has received serious criticism in recent years for characterizing healthy skin as “pink,” which does not adequately address the health of newborns with darker skin.
A 2023 report found that using skin color to detect cyanosis, jaundice, or other disorders in newborns led to both false positive and false negative results. The report stated that more accurate ways to assess an infant’s health by appearance included:
- color of lips
- color of tongue
- pulse oximetry
Other considerations that can affect an Apgar score include sedation or anesthesia of the birthing parent, congenital malformations, gestational age, or trauma. A healthy preterm infant may also score low without actually having oxygen problems.
The maximum score of the Combined-Apgar score is 17, which indicates a baby who hasn’t received any interventions and receives all points. A score of 0 indicates the baby didn’t respond to interventions.
While the Apgar score has value in helping medical providers understand how a baby is doing immediately after birth, the score doesn’t usually have any bearing on how healthy a baby is long term.
Also, because a person is assigning the number, some parts of the Apgar score can be subjective. One person could score a baby a “7” while another could score the baby a “6.”
This is why the Apgar score is just one of several assessments used to evaluate a newborn’s general condition.