Newborn Apgar Score
Score Interpretation
0 - 3 Severely Ill
4 - 6 Moderately Ill
7-10 Healthy
All pink (2 point[s])
Blue extremities and pink body (1 point[s])
Bluish gray or pale all over body (0 point[s])
Heart rate
Over 100 beats per minute (2 point[s])
Less than 100 beats per minute (1 point[s])
Absent (0 point[s])
Normal breathing, baby is crying (2 point[s])
Irregular or slow breathing (1 point[s])
Absent (0 point[s])
Response to nose catheter
Pulls away, sneezes, or cough (2 point[s])
Grimace (1 point[s])
No response (0 point[s])
Muscle activity
Active (2 point[s])
Arms and legs flexed, but little movement (1 point[s])
Limp (0 point[s])


Adapted from Burkow R ed. The Merck Manual. 14th ed. Merck; 1982:1757

Physicians rate a newborn according to the Apgar score devised in 1952 by Virginia Apgar, 1 minute after birth and then at 5 minutes. For some severely ill infants a score will also be given at 10 minutes. This is a scoring system which is used to assess infants for cardiopulmonary and neurologic depression. The lower the score the more profoundly ill the infant is, with scores under 7 being associated with some abnormality at birth.

Low initial score with no improvement after the 5 minute score is associated with neonatal illness. A very low score (especially 3 or lower) may indicate asphyxia (lack of oxygen to the brain). It is rare and indicates that resuscitative measures, such as placing a tube in the baby's trachea to help him breathe or giving oxygen to the baby may be implemented.

A score between 4 and 6 may indicate that further observation is warranted or that the baby's airway needs suctioning or the baby may need oxygen to help him breathe.

Scores of 7 or above indicate the baby is generally considered to be in good health and does not require immediate intervention.

The Apgar score cannot be used to predict long-term potential medical or cognitive problems.

Medically Reviewed by: David Perlstein, MD, FAAP on March 18, 2008

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