Apgar Score Calculator

Evidence-based scoring at 1, 5, and 10 minutes with resuscitation guidance and long-term outcome data

Risk Calculator NRP 2021 Neonatology

—

/10

at 1 min

Select all 5 criteria

A · P · G · A · R

A — Appearance (Color) ?

0Pale or blue all over

1Blue extremities (acrocyanosis)

2Completely pink

P — Pulse (Heart Rate) ?

0Absent

1<100 bpm

2≥100 bpm

G — Grimace (Reflex Irritability) ?

0No response

1Grimace / weak cry

2Cry / cough / sneeze

A — Activity (Muscle Tone) ?

0Limp / flaccid

1Some flexion

2Active motion

R — Respiration ?

0Absent

1Slow / irregular / weak cry

2Good, strong cry

Serial Apgar Assessment — 1, 5, and 10 Minutes

Enter scores at each time point. A 10-minute score is recommended when the 5-minute score remains ≤5. Serial scores carry stronger prognostic weight than any single assessment.

1 Minute

5 Minutes

10 Minutes

5-min Apgar 0–3: Neonatal Mortality

244 / 1,000

neonatal deaths in term infants

Casey et al., NEJM 2001; N=145,627

CP Risk, 5-min Apgar 0–3

7.3%

of surviving term infants develop cerebral palsy

Moster et al., J Pediatr 2001

10-min Apgar = 0 in HIE

100%

death or disability at 18–22 months

Laptook et al., Pediatrics 2009

Frequency of 5-min Apgar ≤6

0.2%

of term births in general population

Thorngren-Jerneck & Herbst, OG 2001; N=1,004,984

Neonatal Mortality by 5-Minute Apgar Score Casey et al., NEJM 2001

N=145,627 singleton infants ≥26 weeks. Term infants (37–42 weeks). Neonatal death = within 28 days.

5-min Apgar	Category	Neonatal Death Rate	Relative Risk vs. 7–10
0–3	Severely depressed	244 per 1,000	RR 59 (95% CI 43–80)
4–6	Moderately depressed	16.5 per 1,000	RR 4.0 (95% CI 2.7–6.1)
7–10	Normal	4.1 per 1,000	Reference

The 1-minute score has substantially lower predictive value for neonatal death than the 5-minute score.

Cerebral Palsy Risk by 5-Minute Apgar Score Moster et al., J Pediatr 2001

Norwegian population cohort, term infants. CP diagnosed by age 8 years.

5-min Apgar	CP Rate (survivors)	Odds Ratio vs. 8–10
0–3	~73 per 1,000	OR 81 (95% CI 43–153)
4–6	~8 per 1,000	OR 8.9 (95% CI 4.0–20)
7	~2 per 1,000	OR 2.1 (95% CI 1.0–4.3)
8–10	~0.9 per 1,000	Reference

Critical Counseling Point

Even with a 5-minute Apgar of 0–3, approximately 92% of surviving infants do not develop cerebral palsy. This is a group-level risk — not an individual prognosis. (Moster et al., J Pediatr 2001)

10-Minute Apgar: Death or Disability in HIE Laptook et al., Pediatrics 2009

NICHD cooling trial cohort; infants with hypoxic-ischemic encephalopathy. Outcomes at 18–22 months. These data apply to the HIE population — not generalizable to all low-Apgar infants.

10-min Apgar	Death or Disability	Death Alone
0	100%	71%
1–3	88%	46%
4–6	61%	24%
7–10	39%	6%

NRP Resuscitation Alignment AAP/AHA NRP 8th ed., 2021

NRP algorithm is governed by clinical assessment, not score thresholds. General correspondence shown.

Score	Typical Clinical Picture	NRP-Aligned Response
7–10	Vigorous cry, good tone, pink, HR ≥100	Routine care: dry, stimulate, maintain temperature.
4–6	Depressed respirations, some tone, HR <100	Supplemental O2. PPV if HR <100 or gasping. Reassess q15 sec.
0–3	Absent respirations, limp, HR <60 or absent	Immediate PPV. Compressions if HR <60 after 30s PPV. Epinephrine if HR remains <60. Consider intubation.

ACOG Committee Opinion 644 (2020): "The Apgar score is not a predictor of individual outcome and should not be used to predict neurologic injury." All data represent population-level associations from peer-reviewed cohort studies.

Source Publications

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260–267.

Original description. Five criteria, 0–2 each, assessed at 1 minute postbirth.

Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001;344(7):467–471.

N=145,627 singleton infants ≥26 weeks. Primary source for neonatal mortality risk by 5-minute Apgar. Establishes superiority of 5-min over 1-min for mortality prediction.

Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: a population-based cohort study in term infants. J Pediatr. 2001;138(6):798–803.

Norwegian population cohort, term infants. Primary source for cerebral palsy risk by 5-minute Apgar category.

Laptook AR, Shankaran S, Ambalavanan N, et al. Outcome of term infants using Apgar scores at 10 minutes following hypoxic-ischemic encephalopathy. Pediatrics. 2009;124(6):1619–1626.

NICHD cooling trial cohort. Defines predictive value of 10-minute Apgar for death and disability in HIE. Data apply to HIE population only.

American Academy of Pediatrics; American Heart Association. Textbook of Neonatal Resuscitation (NRP), 8th ed. Elk Grove Village, IL: AAP; 2021.

Current NRP algorithm. Resuscitation sequence, intervention thresholds, targeted SpO2 by minute of life.

ACOG Committee Opinion No. 644. The Apgar Score. Obstet Gynecol. 2015;126(4):e52–e55. Reaffirmed 2020.

Defines appropriate use and limitations of the Apgar score. Score alone should not direct specific interventions or predict individual neurologic outcome.

Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: a population-based register study of 1 million term births. Obstet Gynecol. 2001;98(1):65–70.

Swedish registry, N=1,004,984 term births. Population frequency of low 5-minute Apgar and associated perinatal outcomes.

Built by Amos Grünebaum, MD. All predictive values are traceable to the publications above. No data were fabricated or extrapolated beyond published values.