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Updated: Dec 30 2021

APGAR Scores

  • .Snapshot
    • A 30-year-old G2P1 woman at 39 weeks of gestation is in active labor. She undergoes a vaginal delivery and gives birth to a baby boy. The baby is vigorously dried and he begins to cry. At 1 minute after delivery, the baby is crying, he has a pink body and but somewhat grey extremities, and his pulse is 130/min. He is moving all 4 limbs and grimaces in response to nasal suction. The nurse calculates an APGAR score of 8. At 5 minutes after delivery, the nurse notes that the baby continues to show good breathing with intermittent crying, is now pink all over, and his pulse is 134/min. The baby coughs and pulls away in response to nasal suction and continues to move all 4 extremities with good tone. The nurse calculates a new APGAR score of 10. Given the baby's strong APGAR scores, he does not undergo any intervention/resuscitation after the five-minute mark.
  • Introduction
    • Overview
      • a scoring system used to assess the newborn at 1 minute and 5 minutes after delivery
      • 90% of neonates have an APGAR score of 7-10
      • APGAR score < 7 at 5 minutes indicates need for further intervention/resuscitation
    • One Minute designed to assess the neonates status and the uterine environment
    • Five Minute designed to assess the neonates status and adaptation to the external world
    • APGAR Scoring System

      Appearance (skin color)

      • Blue body
      • Pink body but blue extremities
      • Body and all extremities are pink
      • Absent
      • < 100/min
      • > 100/min
      Grimace (irritability)
      • No response to nasal suction
      • Grimace response to nasal suction
      • Coughs, sneezes, and pulls away to nasal suction
      Activity (muscle tone)
      • Flaccid
      • Weak muscle tone but some movement
      • Moving 4 limbs with good tone
      • Absent breathing
      • Slow, irregular breathing
      • Good breathing and crying
  • Case Examples
    • 1 MINUTE APGAR: 5
      • A newborn infant at 1 minute has acral cyanosis and weak respiratory effort and respirations are 30/min. Pulse is 105 and a systolic murmur is heard. She has weak reflexes in all 4 extremities only after external stimulation. When her nose and mouth are suctioned there is no response. Her eyes are closed.


    • 1 MINUTE APGAR: 6
      • At 1 minute a newborn's pulse is 90/min, good respiratory rate (crying), pink body with blue extremities, weak muscle tone with flexion of the extremities, and a facial grimace response to nasal suction but no cough/sneeze.
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