Apgar score: how it's calculated
The Apgar score adds up points for five signs in a newborn baby: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone) and respiration (breathing effort). Each sign gets 0, 1 or 2 points, so the total runs from 0 to 10. A baby given 1 for appearance, 2 for pulse, 1 for grimace, 2 for activity and 2 for respiration has an Apgar score of 1 + 2 + 1 + 2 + 2 = 8.
Not a medical device. Not a diagnosis or dosing recommendation.
What is the Apgar score?
The Apgar score is a quick, structured way of describing a newborn's condition in the first minutes after birth. It was proposed by the American anesthesiologist Virginia Apgar, and the five letters of her name are often used as a memory aid for the five signs: Appearance, Pulse, Grimace, Activity and Respiration.
The score is a simple sum. There's no weighting and no formula beyond addition. All the judgment is in deciding how many points each sign earns, which is done by the person examining the baby.
This page explains how the points add up. It doesn't give a cutoff, it doesn't sort totals into bands, and it doesn't say what a score means for a particular baby.
The Apgar score formula
Apgar = appearance + pulse + grimace + activity + respiration
(each 0, 1 or 2; total 0 to 10)Exact expression the calculator uses:
APGAR = appearance + pulse + grimace + activity + respiration; each 0-2; max 10In words: give each of the five signs 0, 1 or 2 points, then add the five numbers together.
What each part means
| Input | Letter | What it describes | Points accepted |
|---|---|---|---|
appearance | A | Color | 0, 1 or 2 |
pulse | P | Heart rate | 0, 1 or 2 |
grimace | G | Reflex irritability | 0, 1 or 2 |
activity | A | Muscle tone | 0, 1 or 2 |
respiration | R | Respiratory effort | 0, 1 or 2 |
score | Total | 0–10 |
How the score works
- Assess each of the five signs.
- Give each one 0, 1 or 2 points.
- Add the five numbers.
- The total is the Apgar score, out of a maximum of 10.
Every sign carries the same weight. A point for color counts exactly the same as a point for heart rate.
Whole numbers
Each sign takes a whole number: 0, 1 or 2. Magent's calculator rejects anything other than 0, 1 or 2 rather than guessing. The calculator doesn't observe the baby; it adds the five numbers it's given and returns each sign's points next to the total.
Worked examples
These use Magent's own expected values for the calculator.
Example 1: appearance 1, pulse 2, grimace 1, activity 2, respiration 2
- 1 + 2 + 1 + 2 + 2 = 8
Example 2: every sign scored 2
- 2 + 2 + 2 + 2 + 2 = 10, the maximum
Example 3: every sign scored 0
- 0 + 0 + 0 + 0 + 0 = 0, the minimum
Example 4: one sign scored 1, the rest 0
- Appearance 1, everything else 0: 1 + 0 + 0 + 0 + 0 = 1
The same total of 1 comes out whichever single sign gets the point. Magent's expected values check each of the five signs this way, so the calculator treats every sign identically.
Apgar score sheet
This sheet lists the five signs in the order the letters spell. The points column shows what can be entered. This calculator doesn't describe what earns each point; the person examining the baby assigns them.
| Letter | Sign | Also described as | Points |
|---|---|---|---|
| A | Appearance | Color | 0 / 1 / 2 |
| P | Pulse | Heart rate | 0 / 1 / 2 |
| G | Grimace | Reflex irritability | 0 / 1 / 2 |
| A | Activity | Muscle tone | 0 / 1 / 2 |
| R | Respiration | Respiratory effort | 0 / 1 / 2 |
| Total | 0–10 |
History of the Apgar score
The score comes from Virginia Apgar's paper A proposal for a new method of evaluation of the newborn infant, published in Current Researches in Anesthesia and Analgesia in 1953 (volume 32, issue 4, pages 260–267).
A 2013 study in PLoS One describes the original purpose: Apgar proposed the system as a rapid means of evaluating the newborn's clinical status and the need for prompt intervention to establish breathing.[1] It describes the score as five easily identifiable components, each given 0, 1 or 2, with the total as their sum.[1]
The same paper explains that a second score taken at five minutes of age became widely accepted after the Collaborative Perinatal Project reported a stronger relationship between the five-minute score and newborn deaths than the one-minute score showed.[1]
When it's used
The 2013 study describes the Apgar score as a standardized, effective and convenient assessment for newborn infants.[1] Its analysis used the score recorded at five minutes.[1]
Where it's used
The same paper says the system has gained widespread application by obstetricians all over the world for more than half a century.[1] Its own data came from about 25.9 million US births in national linked birth and infant death records from 1995 to 2004.[1]
Who uses it
The 2013 study names obstetricians as widespread users.[1] It also notes that the score has been used in ways it was never intended for, such as predicting specific neurological outcomes in term infants.[1]
Limits of the calculation
- It adds five numbers. It doesn't observe the baby or decide the points.
- It doesn't name a condition, and it isn't a resuscitation, prognosis or discharge guide.
- The 2013 study lists factors that can influence a score, including drugs, trauma, congenital anomalies, infections, hypoxia, hypovolemia and preterm birth.[1]
- It also notes that tone, color and reflex irritability partly depend on physical maturity, so a healthy preterm baby can get a lower score simply because of immaturity.[1]
- The record notes that Apgar's 1953 paper defines the five signs and their points but doesn't publish the interpretation bands used later. This page doesn't show those bands.
Clinical decisions belong to a qualified clinician who knows the patient.
Glossary
- Newborn (neonate): a newly born baby; the Apgar score is taken in the first minutes after birth.
- Reflex irritability: how the baby responds to stimulation, the "grimace" in APGAR.
- Muscle tone: how much the baby's muscles resist movement, the "activity" in APGAR.
- Respiratory effort: how well the baby is breathing on its own.
- Preterm: born before 37 weeks of pregnancy.
Common mistakes
- Scoring a sign 3 or higher. The maximum for any one sign is 2.
- Writing a total above 10. Five signs at 2 points each is the ceiling.
- Using half points. Each sign takes a whole number.
- Mixing up the two A's. The first A is appearance (color); the second is activity (muscle tone).
- Treating the total as a verdict. It's a structured description of five signs.
Source
Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
PMID: 13083014
Further reading
- Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar score and infant mortality. PLoS One. 2013;8(7):e69072.
Frequently asked questions
How is the Apgar score calculated?
Give each of five signs (appearance, pulse, grimace, activity and respiration) 0, 1 or 2 points, then add them up. The total runs from 0 to 10.
What is a normal Apgar score?
This page doesn't give a cutoff or sort scores into bands. It adds up the points; what a score means depends on the baby and the clinical context.
What does APGAR stand for?
Appearance, pulse, grimace, activity and respiration. The letters also spell the name of Virginia Apgar, who proposed the score.
What is the highest Apgar score?
10, which is 2 points for each of the five signs.
Why is the Apgar score taken at 1 and 5 minutes?
The 2013 study says a second score at five minutes became widely accepted after a large project found the five-minute score more closely related to newborn deaths than the one-minute score.[1]
Who invented the Apgar score?
Virginia Apgar. The 2013 study says she proposed it in 1952,[1] and her paper describing it was published in 1953.