The APGAR tool is a quick assessment used to evaluate the physical condition of a newborn baby immediately after birth. The tool was developed by Dr. Virginia Apgar in 1952 and has since become a standard practice in obstetrics.
APGAR is an acronym that stands for Appearance, Pulse, Grimace, Activity and Respiration. The tool involves a scoring system where the baby is given a score of 0, 1, or 2 for each of the five criteria. The scores are then added up, and the total score is used to evaluate the baby’s overall condition.
APGAR Assessment Tool
| 0 Points | 1 Point | 2 Points | |
| Appearance (Skin colour) | Cyanotic/Pale all over | Peripheral cyanosis only | Pink |
| Pulse (Heart rate) | Absent | < 100 bpm | > 100 bpm |
| Grimace (Reflex irritability) | No response to stimulation | Grimace or weak cry when stimulated | Cry when stimulated |
| Activity (Tone) | Floppy | Some flexion | Well flexed and resisting extension |
| Respiration | Apneic | Slow, irregular breathing | Strong cry |
APGAR Components
- Appearance: This refers to the colour of the baby’s skin. A score of 2 is given if the baby’s entire body is pink, 1 if the body is pink with blue extremities and 0 if the body is completely blue or pale.
- Pulse: This evaluates the baby’s heart rate. A score of 2 is given if the heart rate is greater than 100 beats per minute, 1 if it is less than 100 beats per minute and 0 if there is no heart rate.
- Grimace: This evaluates the baby’s reflexes and response to stimulation. A score of 2 is given if the baby coughs, sneezes, or cries when stimulated, 1 if there is a minimal response such as facial grimacing and 0 if there is no response.
- Activity: This evaluates the baby’s muscle tone and activity level. A score of 2 is given if the baby has strong, active movements, 1 if there is some flexion or movement but weak and 0 if there is no movement.
- Respiration: This evaluates the baby’s breathing. A score of 2 is given if the baby is crying or breathing normally, 1 if there is slow or irregular breathing and 0 if there is no breathing.
The maximum score on the APGAR tool is 10, and a score of 7 or above is generally considered normal. A score below 7 may indicate that the baby needs medical attention, and further assessment and intervention may be necessary. The APGAR score is not intended to predict long-term outcomes or developmental delays, but rather to provide an immediate evaluation of the baby’s physical condition.