The APGAR score was invented in 1952 by anesthesiologist Virginia Apgar. It is a scoring system ranging from zero to ten and is calculated by evaluating the newborn based on five criteria. Each of these criteria can be allocated a score from zero to two, and then, the sum of these criteria will give you the total APGAR score. In the original article published by Virginia Apgar, the original components of the score were color, heart rate, reflex, irritability, muscle tone, and respiratory effort; however, there is an easier way to remember these criteria by remembering the pneumonic APGAR for appearance, pulse, grimace, activity, and respirations. Typically, the APGAR score is calculated at one and five minutes after birth. If the score is low, you usually repeat the score later. A score of seven and above is generally normal. Scores less than seven are low and suggest distress of the newborn that require some intervention, for example, suctioning or stimulation. Although APGAR scores are not used to determine morbidity or mortality, lower scores are typically thought to correlate with more severe outcomes. For example, scores of three that are persistent can indicate long-term sequela, such as neurologic damage; however, ultimately the purpose of the APGAR score is to determine when emergent interventions are necessary. The APGAR score is as follows: you will take a look at the newborn's appearance. If they are blue or pale, you give them zero points. Blue extremities but a pink body, you'll give them one point, and you will award two points if the body and extremities of the newborn are pink without any cyanosis. For pulse, if it is absent, you score zero points. If the pulse is less than 100 beats per minute, they'll score one point, and in the ideal situation, the newborn's heart rate should be greater than 100 beats per minute, awarding them two points. For grimace, you award zero points if there is no response to stimulation or the baby is floppy. One point is awarded for grimace, or suction, or aggressive stimulation, and again, ideally, if the baby is crying on stimulation, you award them two points. For activity, if the newborn is not moving, you, of course, award them zero points. If there's some flexion of the arms and legs, you award them one point. If there's active flexion against resistance, you award two points. For respirations, if they're absent, you award zero points. For weak, irregular, or slow respirations, one point is awarded, and if the baby is strongly crying, you give them two points.