Newborn APGAR Test: What Is It and What Is It Used For?

Before the Apgar test was designed, many newborn babies died. This was because, even if they weren't sick, they had certain difficulties during delivery or at the time of birth that were detected too late.
Newborn APGAR Test: What Is It and What Is It Used For?
Leidy Mora Molina

Reviewed and approved by the nurse Leidy Mora Molina.

Written by Edith Sánchez

Last update: 29 December, 2022

The APGAR test is the first of the assessments carried out on a baby at birth. This and other tests can establish whether the baby is well or has any problem that needs to be addressed.

The APGAR test was created by Virginia Apgar, an American anesthesiologist, in 1953. It soon became an indispensable tool, helping to reduce neonatal mortality. It also laid the foundation for modern neonatology.

Today, all newborns should undergo the APGAR test. This is performed one minute after birth and repeated five minutes later. The result is a score that shows whether the baby is well or not.

What does the APGAR test consist of?

The APGAR test.
After birth, the Apgar test is performed to determine the newborn’s state of health.

The APGAR test is an assessment of newborn babies. The objective is to detect possible problems quickly and without any discomfort for the baby. The purpose of this test is to provide immediate care to the newborn baby if needed.

In particular, this test is performed to determine if the baby has heart problems or needs help to breathe normally. It’s carried out for the first time within a minute of birth to check if the baby came out of the birthing process in good health.

The test is repeated five minutes later to verify that the baby is adapting well to the new environment they are now in. Sometimes, if there are any doubts, a third test is performed 10 minutes after delivery.

It’s usual for the first results to show low numbers, while the second results are normal. This is more common in cases of complicated labor, cesarean section, or premature birth.

What is measured during the test?

The APGAR test measures five variables. Each of these is given a score from 0 to 2 points, which are then added together. The maximum score a baby can receive is 10, although this is very rare.

Although the word “APGAR” is the name of the doctor who developed the test, it has also become an acronym to facilitate the process involved in the test; each letter refers to one of the variables being tested, as seen below:

  • A: Activity / Muscle tone
  • P: Pulse / Heart rate
  • G: Grimace reflex response
  • A: Appearance (skin color)
  • R: Respiration

Each variable is assigned a score, according to the following criteria:

A: Activity/muscle tone

  • 0 points: Limp or flaccid.
  • 1 point: If the limbs are flexed.
  • 2 points: When there’s active movement.

P: Pulse/heart rate

  • 0 points: None.
  • 1 point: Less than 100 beats per minute.
  • 2 points: More than 100 beats per minute.

G: Grimace response (reflexes)

  • 0 points: None.
  • 1 point: There’s facial movement and response with stimulation.
  • 2 points: The infant coughs or sneezes, cries, and retracts their foot if stimulation is present.

A: Appearance

  • 0 points: The skin appears blue, bluish-gray, or pale all over the body.
  • 1 point: General appearance is pink, but the extremities are blue.
  • 2 points: The infant is pink all over.

R: Respiration (breathing rate and effort)

  • 0 points: None.
  • 1 point: The cry is weak and irregular.
  • 2 points: The cry is regular and powerful.

How are the results interpreted?

A baby at the doctor's.
The test is performed twice: after birth and after 5 minutes.

The APGAR test only serves to establish the baby’s state of health at the time of birth, but doesn’t determine what the baby’s health will be like thereafter. As indicated above, the score is established for each variable and then added up.

For the test carried out one minute after birth, a total score of 7 to 9 is typical. However, a score above 7 is considered normal.

If the score is in the range of 5 to 7 in the first minute, it may require some nursing maneuvers to stabilize the baby. It doesn’t mean that the baby is sick, but does mean it may need help to stabilize.

If the score is 4, it’s still likely that the baby is fine, but needs resuscitation. This is relatively common in complicated deliveries. When the score is less than 4, it means there are problems and they’ll require emergency medical attention.

What can an abnormal result mean?

In most cases, a low APGAR test score is the result of a difficult delivery, cesarean section, or fluid residue in the baby’s airway. Depending on the case, the baby may require one of the following measures:

  • Administration of oxygen
  • Airway clearance
  • Physical stimulation to make the heartbeat more adequate

It’s very important to emphasize that an abnormal test result doesn’t mean that the child was born sick or will have health problems later in life. This test cannot predict anything in the future.

The APGAR test assesses the baby’s general health

This test is one of many carried out when a baby is born. It isn’t designed to establish the baby’s overall health, but rather to quickly detect any situation that requires immediate attention.

Most infants who score low on the test respond very well to the maneuvers or procedures given to them. Because of this, this test should be accepted as a partial and relative indicator.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Alfredo y Quero García-Alix, J. (2012). Tono y fuerza muscular. Generalidades: Evaluación neurológica del recién nacido. Ediciones Díaz de Santos.
  • Alvarado, G., Martínez, I., Solís, M., Plaza, M., Gómez, D., Mandujano, M., & Sánchez, C. (2009). Los reflejos primitivos en el diagnóstico clínico de neonatos y lactantes. Revista de Ciencias Clínicas, 9(1), 15-26.
  • Hübner, M. E., & Juárez, M. E. (2002). Test de Apgar: Después de medio siglo ¿sigue vigente? Revista médica de Chile, 130(8), 925-930.
  • Congreso de Pediatría 2019. Dra María Teresa Sepúlveda. Tono Muscular del Recién Nacido.
  • Arq. Bras. Cardiol. 96 (6) Jun 2011. Variabilidad de la frecuencia cardíaca en neonatos prematuros y de término.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.