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Philadelphia Med Mal & Birth Injury Lawyer / Blog / Birth Injury / What Apgar Stands For & Its Importance in Assessing Newborn Health

What Apgar Stands For & Its Importance in Assessing Newborn Health


After delivery, medical professionals assess the newborn with Apgar scores to determine their health and whether they require additional medical attention. But what exactly is Apgar? Why is Apgar so important? What does Apgar tell me about the health of my baby?

Noted Philadelphia birth injury lawyer Heidi G. Villari explains in this comprehensive article. Learn what Apgar is, how it helps doctors, what Apgar scores mean, what happens if Apgar scores are low, and what parents can do if they believe medical negligence injured their baby, resulting in low Apgar scores.

If you believe your baby suffered an injury due to medical malpractice, call us. We have helped families in the Philadelphia area hold medical providers liable for their negligence for over twenty years. We can help you too.

Apgar Score Definition

A baby’s Apgar score is a ten point evaluation of five health indicators developed by Virginia Apgar in 1952. The five indicators are:

  • A – Appearance
  • P – Pulse
  • G – Grimace
  • A – Activity
  • R – Respiration

What Does Apgar Stand For?

A – Appearance

Appearance refers to the newborn’s skin tone.

Score of 2 – newborn has normal color all over the body with pink palms and soles of their feet.

Score of 1 – newborn may have bluish palms or soles of their feet.

Score of 0 – newborn is bluish, grey, or pale all over.

P – Pulse

Doctors check the newborn’s pulse, or heart rate, to determine whether it is steady, strong, and within normal parameters.

Score of 2 – newborn has a heart rate of 100 beats per minute or more.

Score of 1 – newborn has a heartbeat of less than 100 beats a minute.

Score of 0 – there is no pulse.

G – Grimace

Grimace response refers to reflexes and a newborn’s reflex irritability in response to stimulation.

Score of 2 – newborn pulls away, cries, coughs, or sneezes in response to stimulation.

Score of 1 – newborn changes facial expression (grimaces) in response to stimulation.

Score of 0 – no response to stimulation.

A – Activity

Activity refers to a newborn’s muscle tone.

Score of 2 – newborn is actively moving arms and legs.

Score of 1 – newborn is moving much less than expected.

Score of 0 – no movement, and the newborn may feel limp or floppy.

R – Respiration

Respiration refers to the newborn’s breathing.

Score of 2 – newborn is breathing normally and crying.

Score of 1 – newborn is breathing irregularly with weak crying.

Score of 0 – newborn is not breathing.

When the Apgar Test Is Administered

A doctor administers the APGAR test one minute after delivery and again five minutes after delivery. The test gets administered twice to check for discrepancies. If a second score continues to be low, that may indicate the newborn requires immediate medical attention.

What Do the Apgar Scores Mean?

Doctors add the five scores together. A total Apgar score of seven or higher indicates the baby is normal. A score between four and six may indicate the baby needs assistance breathing. A score below four indicates the baby requires emergency medical care.

Should Parents Be Concerned About a Low Score?

Low scores prompt your medical team to take action to remediate whatever is suppressing your baby’s Apgar score. Your medical team should keep you apprised of your baby’s condition. If any indicator scores low, they first work to stabilize your baby’s condition and then find out what is causing the low score.

A low Apgar score does not necessarily mean your baby is injured or ill. Low one-minute Apgar scores are common in:

  • Premature births
  • Cesarean sections
  • High risk pregnancies
  • Complications arose during labor or delivery

Often it is only a matter of suctioning the airway or administering oxygen before the Apgar scores improve.

Parents should keep in mind the Apgar score does not predict their baby’s health, behavior, or intelligence in the long term. The Apgar test only tells your health care providers a newborn’s overall physical condition at birth, so they have the information they need to determine whether your baby needs immediate care.

Do Low Apgar Scores Indicate Malpractice?

Not necessarily, but a low Apgar score can indicate the baby suffered some distress either before or during delivery, such as oxygen deprivation or HIE. If your baby suffered a lack of oxygen at birth due to the negligence of a medical professional, that is grounds for a medical malpractice lawsuit.

If a baby inherited Cerebral Palsy, they may also have a low Apgar score.

What Causes Low Apgar Scores?

Congenital conditions such as Cerebral Palsy can cause low Apgar scores. Oxygen deprivation and HIE also cause a low Apgar score.

Assisted Apgar Scores Explained

One in ten newborns require assistance breathing just after delivery. This does not necessarily indicate the newborn has suffered a birth injury or will continue to experience medical issues.

Apgar Scores & Birth Injury Malpractice

Medical researchers found a low five-minute Apgar score is strongly associated with high risk of neonatal and infant death.

If your baby had a low second Apgar score, talk with your doctor. They will apprise you of any problems or risk of problems and explain any further medical care they are administering.

Be sure to understand your doctor’s explanation for the low Apgar score. If your baby scored low due to oxygen deprivation or HIE, and that oxygen deprivation or HIE was caused by your medical provider’s negligence, your medical team and the hospital may be liable for your baby’s injuries.

Talk with an Experienced Birth Injury Lawyer

A low Apgar score does not always indicate medical malpractice, but it can. An experienced birth injury lawyer helps you find out if negligence caused oxygen deprivation or HIE, resulting in a low Apgar score. If your baby was permanently injured, they may require medical care and other special services for the rest of their lives. Who is going to pay for that?

If they were negligent, your medical team should. Call us today to discuss your case and put our skill and experience to work for your family.

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