Apgar scoring was developed before the era of care for VLBW/ELBW newborns. Despite occasional reinterpretations of how to score, practically, we can try to maintain the original intest of the assessment. I would score "1" in the instance you mention. Respirations are present but not normal. By the way, Apgar is an eponym (for Virginia Apgar) not an acronym (APGAR). I have been told by many trainees over the years what A, P, G, A & R stand for (unfortunately).