Apgar Score
The Apgar score is a rapid, standardized assessment of a newborn's physiologic condition immediately after birth. Five criteria — Appearance, Pulse, Grimace, Activity, and Respiration — are each scored 0–2 and summed at 1, 5, and (if needed) 10 minutes. It guides the immediate resuscitation response and communicates the infant's transition to extrauterine life.
Pearls for trainees:
- Pulse is the most clinically significant component — a score of 0 here should trigger immediate resuscitation regardless of other scores.
- A 1-minute Apgar does not predict long-term outcome; the 5-minute score is more meaningful.
- Acrocyanosis (blue hands/feet) in an otherwise well infant is common and expected — it scores 1 for Appearance.
- A score that stays ≤6 at 10 minutes is associated with increased risk of adverse neurological outcomes, though it is not diagnostic.
Reference: Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260–267.
Frequently asked questions
What is a normal Apgar score?
7–10 is reassuring, 4–6 is moderately low, and 0–3 is low. A low 1-minute score reflects the need for resuscitation rather than long-term outcome.
Does a low Apgar score predict outcome?
A single low score correlates poorly with long-term outcome. Scores that remain low at 10 minutes and beyond carry more prognostic weight. Apgar is not a measure of asphyxia.
When is a 10-minute Apgar assigned?
When the 5-minute score is below 7, additional scores are assigned every 5 minutes up to 20 minutes.
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