The APGAR score should be obtained and recorded initially and a 5 minutes with the birth or delivery of any infant. If there are problems with the baby an additional score is given at 10 minutes
0
1
2
Sign
Heart Rate
Absent
Respiratory Effort
Muscle Tone
Reflex Irritability
Color
Absent
Limp
Blue, Pale
No Response
< 100 min.
Weak Cry
Some Flexion
Some Motion
Extremities Blue
> 100 min.
Strong Cry
Good Flexion
Cry
Pink
[max total score = 10]
assess at 1, 5min; repeat q5min until score >=7; document individual scores in order presented below, e.g. (2,1,0,1,1)
heart rate
[score 0-2]
2 = HR >100; 1 = HR <100; 0 = HR absent
respiratory effort
[score 0-2]
2 = strong cry; 1 = slow, irregular; 0 = absent
muscle tone
[score 0-2]
2 = active motion; 1 = some flexion; 0 = limp
reflex irritability to suction
[score 0-2]
2 = cough, sneeze; 1 = grimace; 0 = no response
color
[score 0-2]
2 = pink; 1 = acrocyanosis; 0 = blue, pale