Overview
The Apgar score is used to assess the health of a neonate. NICE recommends assessing the Apgar score routinely at 1 and 5 minutes for all births. This is repeated at 10 minutes if the Apgar score is low. It is measured out of 10.
The features assessed in the Apgar score can be remembered using its name:
- Appearance (skin colour)
- Pulse
- Grimace (reflex irritability, the response to stimulation such as a mild pinch)
- Activity (muscle tone)
- Respiratory effort
| Feature | 0 | 1 | 2 |
| Appearance | Blue/pale | Blue extremities, body pink | No cyanosis, pink |
| Pulse | Absent | <100 bpm | ≥100 bpm |
| Grimace (reflex irritability) | No response | Little response (grimace) | Cries on stimulation |
| Activity (muscle tone) | None (floppy) | Limb flexion | Active movement |
| Respiratory effort | Absent | Weak, slow, irregular, gasping | Strong, robust cry |
The features in the Apgar score can also be remembered using the mnemonic ‘How Ready Is This Child?’:
- How – heart rate
- Ready – respiratory effort
- Is – irritability
- This – tone
- Child – colour
Interpretation
Overview and limitations
A score of 0-3 is very low, 4-6 is moderate, and ≥7 suggests the baby is in a good state. The purpose of the Apgar test is to quickly assess if the neonate needs immediate care.
The Resuscitation Council UK assessment is preferred when assessing a baby’s condition and resuscitation needs rather than the Apgar score. A small proportion of babies with very low Apgar scores have a significant neurological disability.
