Reference — Neonatal
APGAR Scoring Reference
APGAR is the standardized snapshot of newborn transition at one and five minutes — five components, each scored 0 to 2. It guides ongoing assessment; resuscitation never waits for it.
Data Source: Virginia Apgar (1953) / AAP-AHA Neonatal Resuscitation Guidelines
Educational use only. Resuscitation decisions follow NRP and provider direction in real time — the APGAR score documents transition, it does not gate intervention. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Five Components (A-P-G-A-R)
| Component | 0 Points | 1 Point | 2 Points |
|---|---|---|---|
| Appearance (color) | Blue or pale all over | Body pink, extremities blue (acrocyanosis) | Completely pink |
| Pulse (heart rate) | Absent | Below 100 bpm | 100 bpm or above |
| Grimace (reflex irritability) | No response to stimulation | Grimace with stimulation | Cry, cough, or sneeze with stimulation |
| Activity (muscle tone) | Limp, flaccid | Some flexion of extremities | Active motion, well flexed |
| Respiration (effort) | Absent | Slow, irregular, weak cry | Strong, vigorous cry |
Interpretation and Timing
| Score | Meaning | Typical Action |
|---|---|---|
| 7–10 | Reassuring — normal transition | Routine care: dry, warm, skin-to-skin, ongoing observation |
| 4–6 | Moderately depressed | Stimulate, clear airway per NRP, support breathing, rescore |
| 0–3 | Severely depressed | Active resuscitation per NRP underway; team mobilized |
Scored at 1 and 5 minutes; if the 5-minute score is below 7, repeat every 5 minutes up to 20 minutes.
Clinical Notes
Acrocyanosis is expected
Blue hands and feet with a pink body in the first hours is normal transition — it scores 1 on Appearance but does not itself signal distress. Central cyanosis (trunk, lips, mucosa) does.
Heart rate dominates
Pulse is the most important single component — a newborn heart rate under 100 drives NRP action regardless of the composite score.
NCLEX Pearls
- ✦Memory aid: APGAR = Appearance, Pulse, Grimace, Activity, Respiration.
- ✦Resuscitation starts when needed — never delayed to compute a score.
- ✦A 5-minute score below 7 means rescoring every 5 minutes to 20 minutes.
- ✦Acrocyanosis scores 1 for color and is normal early; central cyanosis is never normal.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · Neonatal Resuscitation Program (NRP) · AWHONN. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →