Apgar score 0–3 – what does it mean?
⚠︎ Learning page – classification and study figures only, no treatment recommendation.
In short
According to the MSD Manual, an Apgar score of 0–3 (referring to the 5-minute score) is considered low. Virginia Apgar herself grouped scores into 0–3, 4–6 and 7–10 in 1966.
According to the MSD Manual, a low Apgar score is a clinical finding, not a diagnosis.
The figures describe groups in the cited studies, not the risk of an individual person. This page contains no treatment or management recommendation.
How a score of 0–3 comes about
Heart rate, respiration, muscle tone, reflex irritability and colour are each scored 0, 1 or 2 points (total 0–10). 51 of the 243 possible combinations add up to 0–3 points. One example per total:
- 3 (30 combinations), e.g. Heart rate (pulse): < 100/min (1); Respiration: slow, irregular, weak (1); Muscle tone (activity): limp (0); Reflex irritability (grimace): grimace (1); Colour (appearance): blue or pale all over (0)
- 2 (15 combinations), e.g. Heart rate (pulse): < 100/min (1); Respiration: slow, irregular, weak (1); Muscle tone (activity): limp (0); Reflex irritability (grimace): no response (0); Colour (appearance): blue or pale all over (0)
- 1 (5 combinations), e.g. Heart rate (pulse): < 100/min (1); Respiration: absent (0); Muscle tone (activity): limp (0); Reflex irritability (grimace): no response (0); Colour (appearance): blue or pale all over (0)
- 0 (1 combination), e.g. Heart rate (pulse): absent (0); Respiration: absent (0); Muscle tone (activity): limp (0); Reflex irritability (grimace): no response (0); Colour (appearance): blue or pale all over (0)
Timing and notation
Apgar set the first assessment at 60 seconds after birth; it later emerged that the 5-minute score correlates more closely with mortality and later neurological outcome (Apgar 1966). Scores at 1, 5 and 10 minutes are often written with slashes, for example Apgar 9/10/10.
Limitations
According to the AAP and ACOG (2015), the Apgar score alone is neither evidence nor a consequence of asphyxia and does not predict mortality or neurological outcome in the individual infant. A score assigned during resuscitation is not equivalent to that of a spontaneously breathing infant. Scores depend on maturity and birthweight, among other factors (MSD Manual).
All groups at a glance
Calculate it yourself
Enter the criteria in the Apgar score calculator – it runs only in your browser.
FAQ
What does an Apgar score of 0–3 mean?▾
The MSD Manual describes a 5-minute score of 0–3 as low. The score describes the condition immediately after birth; it does not provide a prognosis for the individual infant (AAP/ACOG 2015).
Who defined these groups?▾
In 1966 Virginia Apgar grouped scores into 0–3, 4–6 and 7–10 to compare hospitals. The MSD Manual uses the same groups.
References
- Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953;32:260–7. · PubMed
- Apgar V. The newborn (Apgar) scoring system. Reflections and advice. Pediatr Clin North Am 1966;13:645–50. · PubMed
- American Academy of Pediatrics, American College of Obstetricians and Gynecologists. The Apgar score. Pediatrics 2015;136:819–22. · PubMed
- MSD Manual Professional Edition: Neonatal Resuscitation (Stand 02/2025) – Abschnitt Apgar Score. · msdmanuals.com
Learning page for medical education only: classification and figures reported in the cited sources, no treatment or management recommendation, not for use in patients; not a medical device. Last updated: 10/2026 · Dr. Pascal Bafteh