Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

APGAR Score

 

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

 

  • Each of the 5 parameters should be scored and then totaled.
  • The Minimum score is 0
  • The Maximum score is 10

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