What is the APGAR score and when is it assessed?

APGAR (developed by Virginia Apgar in 1952) is the standard newborn assessment at 1 and 5 minutes after birth. Five categories scored 0-2 each: A — Appearance (color): 0 = blue/pale all over, 1 = pink body with blue extremities (acrocyanosis), 2 = pink all over; P — Pulse (heart rate): 0 = absent, 1 = <100 bpm, 2 = ≥100 bpm; G — Grimace (reflex irritability to stimulation): 0 = no response, 1 = grimace/weak cry, 2 = vigorous cry; A — Activity (muscle tone): 0 = limp, 1 = some flexion, 2 = active movement; R — Respirations: 0 = absent, 1 = slow/irregular, 2 = good crying. Total: 0-10. Interpretation: 7-10 normal; 4-6 moderate distress, may need stimulation/oxygen; 0-3 severe distress, immediate resuscitation. The 5-minute score is generally more predictive of outcomes than the 1-minute. Low APGAR at 5 minutes warrants additional 10-minute (and beyond) reassessments. Note: APGAR scores alone do not diagnose birth asphyxia or predict long-term outcomes; they guide immediate care. Most newborns have acrocyanosis (blue hands/feet) in the first hours, normal and not concerning.