The APGAR score is a quick, standardised assessment of a newborn's transition to extrauterine life, developed by Dr Virginia Apgar in 1952. It evaluates five parameters — Appearance, Pulse, Grimace, Activity and Respiration — each scored 0, 1, or 2, for a total of 0-10.

It is performed at 1 minute and 5 minutes after birth in every delivery. If the 5-minute score is < 7, additional scores are taken every 5 minutes up to 20 minutes.

• Start the timer at complete delivery (not after cord cutting).
• Assess each parameter at exactly 1 min and 5 min — do not delay resuscitation to score.
• Score 7-10: Reassuring. Routine care, skin-to-skin, breastfeeding.
• Score 4-6: Moderate depression. PPV with bag-mask if needed.
• Score 0-3: Severe depression. Full NRP — PPV, chest compressions, epinephrine.
• Document score, time, and assessor in the delivery note.

The Neonatal Resuscitation Program (NRP) India, jointly run by IAP and NNF, is now mandatory training for every Indian birth attendant. The 7th-edition algorithm aligns with AAP-NRP but emphasises:

• Delayed cord clamping (30-60 seconds) for vigorous term and preterm newborns.
• Skin-to-skin contact immediately after birth for thermoregulation — vital in low-resource settings.
• APGAR documented on the WHO partograph and case record — required for IAP-recognised birthing units and NABH-accredited hospitals.
• India's neonatal mortality target (≤12/1,000 live births by 2030) hinges on correct intrapartum assessment.

• Do not delay resuscitation to score — resuscitate based on HR, respiration, tone.
• Preterm babies often score lower due to immature tone and reflex — not necessarily birth asphyxia.
• Maternal sedation (opioids, MgSO₄) can depress APGAR — anticipate at high-risk deliveries.
• A low 1-min APGAR with normalisation by 5 min carries good prognosis; persistent < 5 at 10 min raises concern for hypoxic-ischemic encephalopathy (HIE).