Paediatric & Neonatal Emergency Medicine - Apgar Scoring for Neonatal Assessment Neonatal and Infant Care
Apgar Scoring for Neonatal Assessment
Apgar scoring is a rapid bedside tool to describe a newborn’s physiological condition immediately after birth and to prompt urgent management when needed. It assesses five domains - Appearance, Pulse, Grimace, Activity and Respiration - each scored 0-2 for a total 0-10.
The score is a snapshot of condition at the time of assessment and, while useful for guiding immediate care, has limited standalone prognostic value (NICE NG109; Resuscitation Council UK 2025).
Timing
- Routinely recorded at 1 minute and 5 minutes after birth.
- If the 5‑minute score remains low, repeat at 10 and 15 minutes (and thereafter as clinically indicated) until the infant stabilises (NICE NG109; Resuscitation Council UK 2025).
Five‑item scoring table
Practical notes on assessment
- Measure heart rate quickly with a stethoscope or ECG; pulse oximetry can lag and is less reliable during immediate resuscitation.
- Grimace refers to response to tactile stimulation (for example, flicking the sole or suctioning).
- Colour: transient peripheral cyanosis (acrocyanosis) is common and scores 1; central cyanosis scores 0.
- Do not delay resuscitation to obtain a score.
- The Apgar score reflects the infant’s condition with or without intervention; objective measures (heart rate by stethoscope/ECG, effective ventilation) guide therapy during active resuscitation.