APGAR
Newborn Assessment at 1 and 5 Minutes
Score 0/1/2 each; <7 at 5 min = reassess at 10, 15, 20 min.
On the AANP exam, the APGAR score shows up in any newborn or postpartum vignette and the test rewards candidates who can compute and interpret it without hesitating. Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration — score 0, 1, or 2 each at 1 minute and again at 5 minutes. A 5-minute score under 7 means reassess at 10, 15, and 20 minutes; persistent low scores correlate with neurologic outcomes but rarely change immediate resuscitation, which is driven by the NRP algorithm. Know what each number reflects and what triggers escalation.
- AAppearance (color)0 = blue/pale · 1 = body pink, extremities blue (acrocyanosis) · 2 = completely pink
- PPulse0 = absent · 1 = <100 · 2 = ≥100
- GGrimace (reflex irritability)0 = no response · 1 = grimace · 2 = cry / active withdrawal
- AActivity (muscle tone)0 = flaccid · 1 = some flexion · 2 = active motion
- RRespirations0 = absent · 1 = slow / irregular · 2 = strong cry
Clinical Context
Assigned at 1 and 5 minutes after birth. Scores 7-10 are reassuring; 4-6 moderately depressed; 0-3 severely depressed. If <7 at 5 min, repeat every 5 min up to 20 min.
Important: APGAR does NOT guide resuscitation — those decisions happen within seconds of birth based on the NRP algorithm. APGAR documents the transition. A persistently low 5-minute APGAR combined with cord pH <7.0 suggests intrapartum hypoxic-ischemic encephalopathy — the AANP loves this pairing.
Related Mnemonics
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