NurseSavvy Cheat SheetProcedure
APGAR Scoring
Overview
APGAR is a rapid standardized newborn assessment performed at 1 and 5 minutes after birth, repeated every 5 minutes if the score stays below 7. Five parameters — Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — are each scored 0, 1, or 2 for a total of 0–10. The 1-minute score records the newborn's initial condition; the 5-minute score shows the response to resuscitation. Clinical signs guide immediate resuscitation while another team member records APGAR.
Interpretation
Total APGAR sorts the newborn into one of three action bands.
reassuring threshold
Severe depression: resuscitate
Moderate depression: stimulate + O2
Reassuring: routine care
0
3
4
6
7
10
total score
During — Monitoring
Heart rate is most critical parameter Hallmark
absent=0, below 100=1, at or above 100=2; drives the resuscitation decisionAcrocyanosis scores Appearance 1
blue hands and feet with pink trunk is a normal transitional findingGeneralized cyanosis or pallor scores 0
whole-body discoloration, not just extremitiesCompletely pink body scores 2
uncommon at 1 minute even in healthy newbornsNo reflex response scores Grimace 0
a grimace scores 1; a cough or sneeze scores 2Limp muscle tone scores Activity 0
some flexion scores 1; active movement scores 2Absent breathing scores Respiration 0
slow or irregular breathing scores 1; a good cry scores 21-minute score records initial condition
5-minute score reflects resuscitation effectiveness
correlates with neonatal mortality riskRepeat every 5 minutes if below 7
Vigorous meconium newborn needs dry-stimulate-assess
no routine tracheal suctioning per current NRPTechnique
Dry newborn and clear airway
drying stimulates breathing; patent airway enables effective respirationAssign 1-minute APGAR score
Place skin-to-skin or under radiant warmer
newborns lose heat rapidly by evaporation, convection, radiationApply identification bands to newborn and mother
before separation from motherPerform head-to-toe assessment
Report Nowescalate immediately
Apnea at birth
begin resuscitation immediately while another team member scoresHeart rate below 100 bpmHR < 100 bpm
triggers immediate interventionAPGAR score 0–3total 0–3
severe depression requiring aggressive resuscitationNon-vigorous meconium newborn
poor tone, absent effort, or HR below 100 may warrant tracheal suctioning5-minute score remaining below 7
continue resuscitation and rescore every 5 minutesClinical Pearl
Heart rate is king: absent = 0, under 100 = 1, 100 or above = 2 — and acrocyanosis scores a 1, never a 0.