Apgar score 4–6 – 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 4–6 (referring to the 5-minute score) is considered intermediate. Virginia Apgar herself grouped scores into 0–3, 4–6 and 7–10 in 1966.
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 4–6 comes about
Heart rate, respiration, muscle tone, reflex irritability and colour are each scored 0, 1 or 2 points (total 0–10). 141 of the 243 possible combinations add up to 4–6 points. One example per total:
- 6 (45 combinations), e.g. Respiration: slow, irregular, weak (1); Muscle tone (activity): some flexion of extremities (1); Reflex irritability (grimace): grimace (1); Colour (appearance): body pink, extremities blue (1) – other signs 2 points
- 5 (51 combinations), e.g. Heart rate (pulse): < 100/min (1); Respiration: slow, irregular, weak (1); Muscle tone (activity): some flexion of extremities (1); Reflex irritability (grimace): grimace (1); Colour (appearance): body pink, extremities blue (1)
- 4 (45 combinations), e.g. Heart rate (pulse): < 100/min (1); Respiration: slow, irregular, weak (1); Muscle tone (activity): some flexion of extremities (1); Reflex irritability (grimace): grimace (1); 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 4–6 mean?▾
The MSD Manual describes a 5-minute score of 4–6 as intermediate. 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