Curated insights • How it Works • Practical Pearls • Evidence Base
Do NOT use the APGAR score to determine the initial need for neonatal resuscitation. Resuscitation (if needed) must begin immediately at birth before the 1-minute score is assigned based on the infant's initial tone, breathing, and heart rate.
| Appearance (Color) |
| Pulse (Heart Rate) |
| Grimace (Reflex irritability) |
| Activity (Muscle Tone) |
| Respiration (Breathing) |
| 7–10 |
| 4–6 |
| 0–3 |
A proposal for a new method of evaluation of the newborn infant.
The American Academy of Pediatrics (AAP) and Neonatal Resuscitation Program (NRP) dictate that the APGAR score is a retrospective descriptor of resuscitation efforts, not a trigger. Resuscitation must never be delayed to wait for the 1-minute APGAR.
Developed in 1952 by Dr. Virginia Apgar, an anesthesiologist at Columbia University. She designed the tool to objectively assess the effects of maternal obstetric anesthesia on newborns, standardizing a previously chaotic post-partum assessment.
The backronym (Appearance, Pulse, Grimace, Activity, Respiration) was not Dr. Apgar's original naming. It was coined in 1963 by Dr. Joseph Butterfield as a convenient mnemonic for pediatricians and nurses.
Appearance
Skin Color
Pulse
Heart Rate
Grimace
Reflex Irritability
Activity
Muscle Tone
Respiration
Breathing
Observation Score
Score at 1 and 5 minutes. If 5-minute score < 7, continue scoring every 5 minutes up to 20 minutes. APGAR reflects clinical status but does not predict individual long-term neurological outcome.
