A Nationwide Birth Injury Resource

Apgar Scores and Birth Injuries

When a baby is born, one of the first diagnostic tests performed is the Apgar test. Named after Dr. Virginia Apgar, an anesthesiologist who pioneered neonatal treatment methods, the test is your first look at your baby's health. It is also potentially one of the first warning signs of a significant birth injury.

What is an Apgar score?

The Apgar test was originally named after Dr. Apgar but, as it became widespread, doctors and nurses created an acronym based on the name "Apgar" to remember the five components of the test.

 Element  0  1  2
 Appearance (Skin Color)  Baby is blue or pale all over  Baby's body is pink but extremities are blue  Body and extremities are all pink
 Pulse rate  No pulse  Pulse under 100 beats per minute  Pulse above 100 beats per minute
 Grimace (Reflex irritability grimace)  No response to  stimulation  Baby grimaces on suction or aggressive stimulation  Baby cries on stimulation
 Activity  No activity  Some flexion of arms and legs  Flexed arms and legs with resistance to extension
 Respiration  No respiration  Weak, irregular or gasping for breath  Strong, robust breathing


These five scores are then added together for an overall score between 0-10. In general, scores of seven or above indicate a healthy baby. Four to six indicate some concern. Three or below is critically low and requires immediate intervention.

The Apgar test is performed at the one-minute mark and again at the five-minute mark. If the score remains low, the test may be repeated at 10, 15, 20 or 30 minutes after birth, as needed.

The relationship between low Apgar scores and birth injuries

Apgar tests are primarily intended to lower infant mortality by quickly identifying situations where babies need immediate medical attention. Research has also shown a real correlation between low scores on the five-minute Apgar test and brain injury. That correlation increases if the score remains low at 10 minutes, 15 minutes or 20 minutes.

Again, this is a correlation, not a guarantee. Not every baby with a low Apgar score has brain damage, and not every baby with brain damage has a low Apgar score. The important thing is to appropriately follow up. Doctors who treat babies with low Apgar scores need to order indicated medical tests, communicate with the parents about any risks, perform appropriate treatments if there are signs of brain damage and follow up with a pediatrician or other appropriate specialist.

If your child had a low Apgar score and is now experiencing developmental delays or other warning signs, there is a possibility that medical negligence was involved in their injury. If you weren't warned of potential complications or issues, it's important to get a second medical opinion. It's also important to schedule a free consultation with an attorney in your jurisdiction who can break down your child's legal rights and options.