Version October 2024
| Instructions: The rater should observe the neonate for 2 minutes and then score each individual item for its most extreme manifestation observed during the 2-minute period. | |||
| Parameter | Points | Score | |
| Alertness | Quiet sleep (eyes closed, facial movement absent) | 1 | |
| Active sleep (eyes closed, facial movements present) | 2 | ||
| Quietly awake (eyes open, minimal facial movements) | 3 | ||
| Actively awake (eyes open, facial movements present) | 4 | ||
| Awake and hyperalert | 5 | ||
| Calmness/agitation | Calm (appears lucid and serene) | 1 | |
| Slightly anxious (shows slight anxiety) | 2 | ||
| Anxious (appears agitated but remains in control) | 3 | ||
| Very anxious (appears very agitated, just able to control) | 4 | ||
| Panicky (severe distress with loss of control) | 5 | ||
| Respiratory response (assess only in mechanically ventilated neonates) | No spontaneous respiration | 1 | |
| Spontaneous respiration on ventilator | 2 | ||
| Unrest or resistance to ventilator | 3 | ||
| Actively breathes against ventilator or coughs regularly | 4 | ||
| Fights ventilator | 5 | ||
| Crying (assess only in nonintubated neonates) | No crying | 1 | |
| Faint crying | 2 | ||
| Soft crying or moaning | 3 | ||
| Hard crying | 4 | ||
| Intense crying or screaming | 5 | ||
| Body movement | No or minimal movement | 1 | |
| ≤3 slight arm/leg movements over 2 minutes | 2 | ||
| >3 slight arm/leg movements over 2 minutes | 3 | ||
| ≤3 vigorous arm/leg movements over 2 minutes | 4 | ||
| >3 vigorous arm/leg movements over 2 minutes, or whole body is moving | 5 | ||
| Facial tension | Facial muscles fully relaxed; relaxed open mouth | 1 | |
| Normal facial tension | 2 | ||
| Intermittent eye squeeze and brow furrow | 3 | ||
| Continuous eye squeeze and brow furrow | 4 | ||
| Facial muscles contorted and grimacing (eye squeeze, brow furrow, open mouth, nasal-labial lines) | 5 | ||
| Muscle tone (observation only) | Muscles fully relaxed (open hands, dribbling, open mouth) | 1 | |
| Reduced muscle tone; less resistance than normal | 2 | ||
| Normal muscle tone | 3 | ||
| Increased muscle tone (clenched hands and/or clenched bent toes) | 4 | ||
| Extreme muscle tone (rigidity and flexion of the fingers and/or toes) | 5 | ||
| Total score (range 6-30) | |||
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