Apgar Score Calculator

This is an estimate for education. It does not diagnose anything and does not replace clinical judgement.

What the score is

Virginia Apgar devised the score in 1952 as a rapid way of describing a newborn's clinical condition immediately after birth and the response to any resuscitation given. Five signs — colour, heart rate, reflex irritability, muscle tone and respiration — are each scored 0, 1 or 2, giving a total out of 10. It is reported at 1 minute and 5 minutes for every infant, and then every 5 minutes up to 20 minutes for infants scoring under 7 at 5 minutes.

The descriptors used on this page are taken from the expanded Apgar score form published by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in Committee Opinion No. 644.

What the total means

For the 5-minute score in a term or late-preterm infant, the joint AAP/ACOG document defines three bands: 7 to 10 is reassuring, 4 to 6 is moderately abnormal, and 0 to 3 is low. A score of 0 to 3 at 5 minutes or later is described there as a non-specific sign of illness which "may be one of the first indications of encephalopathy".

Two operational rules follow from the score. A 5-minute score under 7 should be repeated every 5 minutes for up to 20 minutes. A 5-minute score of 5 or less should prompt obtaining an umbilical artery blood gas from a clamped section of cord where possible, and submitting the placenta for pathologic examination may be valuable.

What it is not for, in the guidance's own words

This is where the Apgar score is most often misused, so the recommendations are worth quoting directly. "The Apgar score does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose." And: "It is inappropriate to use the Apgar score alone to establish the diagnosis of asphyxia."

The score is also not the trigger for resuscitation. Neonatal Resuscitation Program guidance is explicit that resuscitation must be started before the 1-minute score is assigned, so the score plays no part in deciding whether to resuscitate, what to do, or when. A score assigned during a resuscitation is not comparable to one from a spontaneously breathing infant, because the interventions change several of the elements being scored — which is why the expanded form records oxygen, positive-pressure ventilation, intubation, chest compressions and adrenaline alongside the numbers.

At a population level a low 5-minute score does carry information: scores under 5 at 5 and 10 minutes confer a substantially increased relative risk of cerebral palsy, and the degree of abnormality tracks with that risk. But population risk is not individual prediction, and most infants with low Apgar scores do not develop cerebral palsy.

Why a low score often means nothing worrying

Several things depress the score without indicating compromise: gestational age above all, maternal sedation or anaesthesia, congenital malformations, birth trauma, and straightforward interobserver variability. Tone, colour and reflex irritability are subjective and depend on physiologic maturity, so a healthy preterm infant may score low purely on immaturity. Normal transition matters too — oxygen saturation targets in the Neonatal Resuscitation Program are only 60-65% at 1 minute and 80-85% at 5 minutes, so a baby who is not yet pink at 1 minute may be entirely on track.

The change between the 1-minute and 5-minute score is more informative than either number alone, because it describes the response to whatever was done.