Apgar Score Calculator
Apgar Score Calculator
Five signs, 0 to 2 each, at one and five minutes. The score describes the newborn’s condition at that moment and nothing else: the AAP and ACOG state that it does not predict individual mortality or neurologic outcome and that by itself it does not equal asphyxia.
Apgar score
5 signs, 0 to 10Heart rate 140 (2); slow irregular respiration (1); some flexion (1); grimace to suction (1); pink body with blue hands and feet (1)
Scoring, and the four things the score is not
Assigned at 1 and 5 minutes, and every 5 minutes to 20 minutes while the score is under 7 · five-minute categories 0–3 low · 4–6 moderately abnormal · 7–10 reassuring
- not a predictor
- the joint AAP/ACOG statement’s own wording is that the score “does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose”. Scores under 5 at 5 and 10 minutes are associated with an increased risk of cerebral palsy across populations, and most infants with such scores do not develop it
- not asphyxia
- “the Apgar score by itself does not equal asphyxia”. Identifying a perinatal hypoxic-ischaemic event needs a multimodal assessment — clinical examination, blood gas and other laboratory results, imaging and electroencephalography — not a number from the first minute of life
- not a resuscitation trigger
- resuscitation starts before the one-minute score can be assigned, so the score cannot decide whether to begin it or which step to take. The one place the statement gives the score a decision-adjacent role is a score of 0 beyond 10 minutes, where it may inform whether resuscitation continues
- confounded, item by item
- gestational age and birth weight move tone and respiratory effort; maternal sedation and general anaesthesia move reflex irritability; any resuscitation in progress moves respiratory effort and colour; trauma, congenital anomalies and interobserver variability move the whole total. A score is not a diagnosis, and the derivation population here is simply newborn infants in the first 20 minutes of life
Worked example
Heart rate 140 (2); slow irregular respiration (1); some flexion (1); grimace to suction (1); pink body with blue hands and feet (1)
2 + 1 + 1 + 1 + 1 = 6 points, in the 4–6 moderately abnormal five-minute stratum
Now suppose this infant is 27 weeks' gestation. Tone and respiratory effort may both be scoring low for immaturity alone — the statement's words are that “the healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity” — and the same 6 means something different
Now suppose the infant is receiving mask ventilation. The respiratory item has nothing spontaneous to grade, and a score assigned during resuscitation “is not equivalent to a score assigned to a spontaneously breathing infant”. Record the interventions beside the number
If this were the five-minute score and it were 5 or less, the joint statement recommends an umbilical arterial blood gas from the clamped cord and consideration of placental pathology
What the 6 does not tell anyone: whether this infant will die, whether they will have cerebral palsy, or whether an asphyxial event occurred. A single value is a snapshot of one examination: a child whose illness is evolving can score differently an hour later, so a reassuring score does not exclude deterioration, and the trend across serial assessments by the same examiner carries more than any one reading.
The five signs
| Sign (mnemonic) | 0 | 1 | 2 |
|---|---|---|---|
| Colour (Appearance) | Blue or pale all over | Pink body, blue extremities | Pink all over |
| Heart rate (Pulse) | Absent | Under 100/min | Over 100/min |
| Reflex irritability (Grimace) | None | Grimace | Sneeze, cough |
| Muscle tone (Activity) | Limp | Some flexion of extremities | Active |
| Respiration | Absent | Irregular, slow | Good, crying |
What a low score is confounded by, and what the joint statement says
| Factor | Effect on the score | Why the number alone cannot be read |
|---|---|---|
| Gestational age and birth weight | Lowers tone and respiratory effort | The statement: a healthy preterm infant with no evidence of asphyxia may score low from immaturity alone, and low scores are inversely related to birth weight. |
| Resuscitation already in progress | Changes respiration and colour | The statement: a score assigned during resuscitation is not equivalent to one assigned to a spontaneously breathing infant. The expanded reporting form records oxygen, positive pressure, compressions and adrenaline at each interval. |
| Maternal sedation or general anaesthesia | Lowers reflex irritability | A pharmacological effect on the mother, read off the infant. |
| Interobserver variability | Moves any item | Reducing it is the stated reason the joint statement recommends a standardised expanded reporting form. |
| Skin pigmentation | Affects the colour item | The MSD Manual notes the colour criterion may be less useful prognostically in non-White newborns. |
A description of a moment, routinely read as a prediction
Virginia Apgar introduced the score in the early 1950s to answer one question: what is the condition of this newborn infant, right now, on five things an examiner can see and hear? Heart rate, respiratory effort, muscle tone, reflex irritability and colour, each 0, 1 or 2, assigned at one minute and five minutes and then every five minutes to twenty while the total stays under 7. It is a good instrument for that question, it is almost universally recorded, and the arithmetic takes a reader three seconds. The useful content of this page is therefore not the sum.
It is what the score is not for, because the misuse is persistent enough that the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have published jointly on it, most recently in 2015, in a statement whose stated purpose is “to place the Apgar score in its proper perspective”. Three sentences from it do most of the work. The score “does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose”. “The Apgar score by itself does not equal ‘asphyxia’” — identifying a perinatal hypoxic-ischaemic event takes a clinical examination, laboratory results, imaging and electroencephalography together. And a low or reassuring score alone does not indicate what an individual baby’s future health will be.
The reasons are mechanical rather than statistical. A healthy preterm infant can score low on tone and respiratory effort from immaturity alone, with no evidence of asphyxia anywhere; maternal sedation flattens reflex irritability; and an infant already receiving positive pressure has no spontaneous respiratory effort to grade, which is why the statement says an Apgar score assigned during resuscitation is not equivalent to one assigned to a spontaneously breathing infant and why it recommends an expanded reporting form with the interventions ticked off beside each interval’s score. Nor does the score decide the resuscitation: resuscitation has already started by the time the one-minute score exists. The single place the statement attaches a laboratory action to a number is a five-minute score of 5 or less, which it says should prompt an umbilical arterial blood gas from the clamped cord and consideration of placental pathology.
A score is not a diagnosis, and a published figure describes the cohort it came from rather than the child in front of you. A single value is a snapshot of one examination: a child whose illness is evolving can score differently an hour later, so a reassuring score does not exclude deterioration, and the trend across serial assessments by the same examiner carries more than any one reading. The derivation population is newborn infants in the first twenty minutes of life and the score describes exactly that interval; the strata printed here are the 2014 reporting categories quoted in the joint statement, not outcome predictions. Published item wordings and severity bands differ between sources and between units, so the reader’s own unit’s chart and protocol take precedence over any banding printed here.
Frequently asked questions
What is a normal Apgar score?
7 to 10 at five minutes is the category the 2014 reporting standards call reassuring; 4 to 6 is moderately abnormal and 0 to 3 is low. A 10 is uncommon rather than ideal, because peripheral cyanosis is normal in the first minutes of life and costs the colour item a point in a perfectly well newborn.
Does a low Apgar score mean the baby was asphyxiated?
No. The AAP and ACOG state jointly that “the Apgar score by itself does not equal ‘asphyxia’”. Identifying a perinatal hypoxic-ischaemic event requires a multimodal assessment — clinical examination, blood gas and other laboratory results, imaging and electroencephalography. A low score is a clinical finding, not a diagnosis.
Can the Apgar score predict cerebral palsy or developmental outcome?
Not for an individual infant. The joint statement says the score “does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose”. Scores under 5 at 5 and 10 minutes are associated with increased cerebral palsy risk across populations, and the great majority of infants with such scores do not develop it.
How do you score the Apgar in a baby who is being ventilated?
The respiratory item has no spontaneous effort to grade, and the joint statement says an Apgar score assigned during resuscitation is not equivalent to one assigned to a spontaneously breathing infant. Use the expanded reporting form, which records the supplemental oxygen, positive pressure ventilation, chest compressions and adrenaline in use at each scoring interval, so a reader can see what the number was measured against.
Why does a preterm baby get a lower Apgar score?
Because tone and respiratory effort are immature. The statement’s own wording is that “the healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity”, and that low scores are inversely related to birth weight. Comparing a preterm infant’s total with a term infant’s is comparing two different things.
Related calculators
References
- American Academy of Pediatrics Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar Score. Pediatrics. 2015;136(4):819–822. doi:10.1542/peds.2015-2651 (also ACOG Committee Opinion 644). The publisher’s full text could not be retrieved for this page; the statement’s wording is quoted here as reported by Contemporary Pediatrics, 10 November 2015, and by OpenAnesthesia, both read in full.
- Contemporary Pediatrics. AAP recommends Apgar score expansion. 10 November 2015 (accessed 10 October 2026) — the source of the quoted wording of the 2015 AAP/ACOG statement used on this page.
- MSD Manual Professional Edition. Neonatal Resuscitation; and Apgar score (medical calculator). Rahway, NJ: Merck & Co (accessed 10 October 2026) — the source of the 0/1/2 criteria reproduced here.
- OpenAnesthesia. Apgar scoring. American Society of Anesthesiologists (accessed 10 October 2026).
Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/