Apgar Score

Assessment criteria and scoring system

To objectify the newborn's condition after birth, five key criteria are used. Each of these parameters is assessed by a specialist on a three-point scale — from 0 to 2 points. The sum of the points allows forming a clinical picture.

In international practice, for the convenience of remembering the criteria, the English acronym APGAR is often used:

• Appearance (Skin color) — assessment of skin coloration. Allows detecting the presence of cyanosis or pathological pallor.
• Pulse (Heart rate) — counting the heart rate (HR), reflecting the adequacy of cardiac activity.
• Grimace (Reflex irritability) — reflex excitability. The physician assesses the newborn's reaction to tactile stimulation.
• Activity (Muscle tone) — severity of muscle tone, as well as the presence or absence of spontaneous voluntary movements.
• Respiration (Breathing) — analysis of the presence, rate, and adequacy of respiratory movements.

Assessment timing

The assessment of the newborn's condition is strictly regulated in time. Compliance with the timing is critically important for correctly monitoring the dynamics of the child's condition.

1. Standard protocol. In routine practice, the assessment is performed strictly twice: at 1 and 5 minutes of life. It is important to emphasize that this rule is universal. It is strictly observed regardless of how severe the infant's initial condition was and regardless of the scope of resuscitation measures that may have already been initiated.
2. Extended protocol. In situations where the child's condition has not stabilized by the 5th minute of life and resuscitation measures are ongoing, the physician is obliged to perform a third assessment. It is performed at the 10th minute of life.

Clinical interpretation and indications for resuscitation

After calculating the total score, the physician determines the severity of the child's condition (in particular, the severity of asphyxia) and decides on further management tactics.

• 1–3 points — the clinical picture indicates severe neonatal asphyxia.
• 4–6 points — the condition corresponds to moderate asphyxia.
• ≤ 6 points — this indicator is the intervention threshold. Such a score is regarded as a direct indication for performing a primary resuscitation complex.

Important condition: primary neonatal resuscitation begins in the presence of indications (including a low Apgar score), but strictly provided that the child has at least one of the four reliable signs of live birth:

• Presence of spontaneous breathing;
• Heartbeat (measurable heart rate);
• Umbilical cord pulsation;
• Voluntary muscle movements.

Note: If the fetus lacks absolutely all four of the above-mentioned signs at birth, medical personnel register them as stillborn.

Class and exam questions

What else to study on this topic

• Clinical picture of severe neonatal asphyxia (1-3 points)
• Pathophysiology of acrocyanosis and generalized pallor
• Primary resuscitation protocol for scores of ≤ 6
• Methodology for testing newborn reflex excitability

Other topics in "Chapter 13. Main syndromes requiring emergency care"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.