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Virginia Apgar
The APGAR score is a rapid assessment tool to evaluate the neonate's overall health. Five criteria are examined and a score of 0, 1, or 2 is assigned. These five values (Appearance, Pulse, Grimace, Activity and Respiration) are totaled for the APGAR score. Scores are affected by many factors including genetic defects, gestational age, or pregnancy related complications including hypoxia and trauma.
1 and 5 Minutes
(1)-Wand to (5)-Hand Minutes-clock

The neonate is assessed using this score at intervals of 1 and 5 minutes after birth. The APGAR score may not be completed if the neonate requires resuscitation.


Assess skin coloration.
0 = Blue or pale.
1 = Body pink, extremities blue.
2 = Completely pink


Assess heart rate.
0 = Absent
1 = Slow (<100 bpm)
2 = Normal (>100 bpm)
Remember that a neonate's normal heart rate lies between 120-160 bpm.


Asses reflex irritability and crying.
0 = No response
1 = Grimace
2 = Grimace with Cough, Sneeze, or Cry

Activity and Muscle Tone
Active with Muscle Tone

Assess flexion of the extremities.
0 = Flaccid
1 = Some flexion
2 = Good flexion


Assess breathing rate and effort.
0 = Absent
1 = Slow or Irregular
2 = Regular respiration or Crying

Total Scores
Total Scoreboard

The total of each of the 5 areas are added together for the final APGAR Score. These scores indicate 0-3 = Severe distress, 4-6 = Moderate Distress, 7-10 = Minimal to no distress

Gentle Stimulation
Gently Stimulating

Neonates in moderate distress at 1 minute often improve with gentle stimulation. This stimulation includes tactile methods, such as touching or rubbing the neonates back.


A neonate who is initially cyanotic may have an indication for oxygen therapy. Oxygen therapy should be initiated using the blow by method and should not be continued long term per the physician's orders.


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