Apgar Score for Newborn Health Assessment | Birth Injury Diagnosis

What Is An Apgar Score?

The Apgar score was developed in 1952 as a simple and repeatable method to quickly assess the health and vital signs of a baby immediately after birth.  Dr. Virginia Apgar, the creator of the score, believed that the same signs that were traditionally used by anesthesiologists to monitor a patient’s condition during surgery could be used to assess a baby’s condition after birth and predict the likelihood of survival.

Apgar testing is typically done at one and five minutes after a baby’s born, and it may be repeated at 10, 15, 20 minutes, or later if the scores remain low. The Apgar score is calculated by evaluating the baby on five criteria using a scale from 0 to 2, then adding the five values obtained.

The five criteria assessed in the Apgar score are:

  • Appearance/complexion: Is the baby blue or pale all over, is the baby blue at the extremities, or is the baby pink?
  • Pulse rate:  Is the baby’s heart rate absent, slow (<100 beats per minute (bpm), or fast (>100 bpm)?
  • Reflex irritability: Does the baby have no response to stimulation such as a mild pinch (is he or she floppy?), does the baby grimace and give a feeble cry, or does the baby cry and pull away when stimulated?
  • Activity: Does the baby exhibit no activity, have some flexion (joint movement), or does the baby have flexed arms and legs that resist extension?
  • Respiratory effort: Is the baby breathing, does the baby have a weak, irregular respiratory effort, or is his or her cry really strong?

Apgar Scoring System - Diagnosing Cerebral Palsy, HIE and Birth Injuries

Apgar Scores

What Do the Letters in APGAR Stand For?

The Apgar score was named after its creator, Dr. Virginia Apgar. When the scoring system was put into common use, medical professionals aligned the criteria assessed during an Apgar test with the letters of the doctor’s last name so that each criterion would be easier to remember:

  • A – Activity (muscle tone)
  • P – Pulse (heart rate)
  • G – Grimace (reflex response)
  • A – Appearance (skin color)
  • R – Respiration (breathing ability)

What Do Apgar Scores Mean?

  • Apgar scores of 1-3 are critically low
  • Apgar scores of 4-6 are below normal
  • Apgar scores of 7+ are typically considered normal

A low Apgar score indicates that a baby is likely to need medical intervention following delivery; the lower the score, the more alert the medical team should be to the possibility of intervention. For example, a baby with a low score is more likely than a baby with a high score to need resuscitation.  When a baby requires resuscitation, it means that the baby needs assistance to restore heart rate, blood pressure, and/or breathing ability.  Some components of the Apgar score are subjective, and there are cases in which a baby requires urgent medical treatment despite having a high Apgar score.

If the score remains low at later times, such as at 10, 15, or 20 minutes after birth, there is a risk that the child will suffer long-term neurological damage. This may include a significant increase in the risk of cerebral palsy. Higher Apgar scores, however, do not rule out the possibility that the baby has a brain injury, such as hypoxic-ischemic encephalopathy (HIE). In these cases, physicians must recognize other signs and symptoms of damage and treat them quickly and appropriately.

It is important to remember that the purpose of the Apgar score is to quickly determine whether a newborn needs immediate medical care; it was not devised to make-long term predictions regarding the baby’s health. A low Apgar score means that a baby is more likely to need urgent medical care, while a high Apgar score means a baby is less likely to need this type of care.

Causes of Low Apgar Score

Causes of Low Apgar ScoreA wide range of complications, injuries, and conditions can result in low Apgar scores. Importantly, anything that causes a baby to become oxygen deprived can result in a low Apgar score after birth. Listed below are a few of the conditions that can cause a low Apgar score:

When a child has a brain injury such as HIE or cerebral palsy, it is imperative that experts rely on objective scientific methods and direct observation to determine if the child was exposed to damaging hypoxia/asphyxia around the time of birth. Clinical markers should be examined and all possibilities of causes explored so that the cause and timing of the brain injury can be pinpointed.

What Happens If My Baby Has a Low Apgar Score?

Some babies with low Apgar scores at birth go on to be perfectly healthy. Most babies with low Apgar scores at birth need immediate attention to help begin or restore heart rate function, breathing ability, or blood pressure levels. If your baby has a low Apgar score at or shortly after birth, medical professionals must be on high alert and must provide immediate medical intervention if necessary. Oftentimes, high-risk infants will be moved to the neonatal intensive care unit (NICU) in order to receive appropriate care. Common medical interventions for newborns with low Apgar scores may include resuscitation, hypothermia therapy in cases of HIE, and many other preventative treatments.

What is an Assisted Apgar Score?

An “assisted Apgar score” is an Apgar score that is assigned while a baby receives breathing assistance. This expanded scoring system is used for babies that need resuscitation at birth and does not use the same criteria as the scale used for babies who are able to breathe on their own. For example, it would be misleading to assign the same Apgar score to a baby who is being ventilated and a baby who is able to breathe on their own at five minutes of birth, even though the two may have similar measured respiration rates. The assisted Apgar score helps account for these varying clinical conditions and provide a more accurate assessment of newborn health. At this time, the predictive reliability of assisted Apgar scores has not been thoroughly studied, and standards for what criteria should be assessed, vary.

How Do You Pronounce Apgar?


Legal Help for Birth Injuries | Reiter & Walsh, P.C.’s Legal Experience and Focus on Birth Injury

When delivery complications arise, it is the responsibility of the medical team to act quickly and appropriately to minimize the risks to the mother and baby.  Failure to appreciate the significance of a low Apgar score can lead to failure of the medical team to act quickly. If the physician or medical team fail to properly monitor a baby or to act skillfully and quickly when complications occur, it is negligence. If a hospital is ill-prepared to perform resuscitation procedures or the medical team improperly performs the procedures, it also is negligence. If this negligence results in injury to the baby, it is medical malpractice.

Due to the complex nature of birth injury cases, it is essential to work with an attorney or attorneys that have a lot of experience in the field and are skillful at reading lengthy and complex medical records. In addition, the attorney should be very knowledgeable about the science involved in birth injury cases. Jesse Reiter has decades of experience in this area, and his practice focuses exclusively on birth injury. He has helped numerous families whose children have HIE, cerebral palsy, and other birth injuries. Many of his cases involve the use of Apgar scoring.


“Jesse Reiter is a remarkable and well experienced birth injury lawyer. We hired Reiter & Walsh after reading about Mr. Reiter’s professional profile and years of experience. We were very happy with the services he provided and admire his professional excellence. He conducted professional and ethical manners; he worked with great dignity. Throughout the legal process, we were informed.

They’re inspiring lawyers with a purpose. Our family was blessed to have them walk us through the legal process that was foreign to us at the time. They worked for us 24/7 and were never too busy to answer all our questions. We absolutely loved working with them!

We wish Reiter & Walsh much strength to serve families that deserve better outcomes, and we shine a light to their lives, just as she did with ours. We are highly satisfied with their professional services and wish them the best of luck.”

-Client review from 10/06/2017

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