Words APGAR SCORE composed of wooden letters.APGAR stands for appearance, pulse, grimace, activity, respiration. Created by Dr. Virginia Apgar in 1952, this scoring system enables medical practitioners to quickly assess the health of a newborn baby within the first five minutes after birth and determine if immediate medical care should be given.

What Does APGAR Measure?

The acronym APGAR makes it easy to remember the five criteria in this scoring system. Each item is rated on a scale of 0 to 2, with 2 being the best score.  Doctors are required to score the apgar to monitor the baby’s condition of a newborn infant.  It can determine many different risk factors including pulse heart rate, skin color appearance, slow or irregular heartbeat, or if the the infant is perfectly healthy.

  • A stands for appearance – this is an evaluation of the color of the baby’s skin. If the body is pink and the extremities are blue, the infant gets a 1 score. However, if the skin is pink all over, the infant scores 2 for color. The baby then gets zero points if the skin is pale or blue all over.
  • P stands for pulse – this is an evaluation of the heart rate of the baby. For this category, the baby scores 2 points if the heartbeat is fast or measuring 100 to 140 beats per minute. Meanwhile, a pulse of less than 100 gets 1 point while the absence of a heartbeat receives zero points.
  • G stands for grimace – this is an evaluation of the reflex irritability or response of the baby at birth. The highest score of 2 is given to an infant that cries when stimulated. On the other hand, if there is no response to stimulation, the score is zero. Babies that respond with a grimace get 1 point.
  • A stands for activity – this is an evaluation of the baby’s muscle tone. The doctor, midwife, or nurse gives a score of 2 if the baby shows active motion with well-flexed muscles that resist extension. However, if the baby is limp or floppy, the medical team scores zero points. An infant that shows some flexion or joint movement gets 1 point.
  • R stands for respiration – this is an evaluation of the breathing ability of a newborn baby. An infant that is breathing well and crying normally gets a 2 score. On the other hand, a baby that is not breathing at all gets zero points. Babies with a weak cry and slow breathing get a 1 score.

The sum of the scores in each category will be the total Apgar score.  A score of 10 would mean that a newborn is perfectly healthy.  A low score of three or less would indicated that doctors and nurses need be on alert.  A low score does not mean necessarily that there is an immediate problem, but the potential is there and the baby should be closely monitored.

How Is Apgar Testing Done?

The baby is evaluated immediately after birth, usually 5 minutes after birth. However, if the initial Apgar score is low, the test may be repeated at 10-, 15-, and 20-minute intervals to assess any improvement.

What Does The Apgar Score Tell Your Doctor?

Apgar scores of 0-3 are critically low and, in which case, the baby may need immediate medical intervention.

Apgar scores of 4-6 are below normal, implying that the infant likely requires medical intervention.

The aim is to get an Apgar score of 7 or higher, which implies that the baby is normal.

Although a high Apgar score may keep parents at ease, it does not rule out the possibility of a brain injury such as hypoxic-ischemic encephalopathy (HIE). The medical team must be quick to recognize other signs and symptoms of brain damage and treat them accordingly.

Another issue with this test is that some components of the Apgar score are subjective.  As such, there may be cases where a baby requires urgent medical attention despite having a high Apgar score.

On the other hand, a low Apgar score does not automatically mean that the baby will have long-term health issues.  However, there is strong evidence that infants with a low Apgar score at five minutes or later are highly likely to suffer long-term neurological damage.

In a 2018 study by Swedish professor Martina Persson, they found that babies with lower Apgar scores at five and 10 minutes were at higher risk for developing cerebral palsy and epilepsy.  Three years earlier, Kari Kveim Lie of the Norwegian Institute of Public Health published a study revealing a significant increase in the risk of cerebral palsy in infants with low Apgar scores at the five-minute mark – despite having a normal birth weight.

Pregnancy and Apgar Scores

Complications during pregnancy and delivery may cause oxygen deprivation to the baby and lead to low Apgar test scores. These issues include:

Apgar Scores and Medical Malpractice

In cases where an infant scores very low on the Apgar scale, and physicians fail to act quickly and appropriately, the birth injuries resulting from this negligence is considered medical malpractice.

Why You Should Seek Legal Help For Birth Injuries

Cases involving birth injuries are complex in nature, which makes it necessary to hire an expert lawyer if you intend to sue your doctor for medical malpractice.

Backed by years of legal experience, the winning attorneys at The Clark Law Office are knowledgeable at assessing lengthy and complicated medical records. We offer a free, confidential, no-obligation consultation for families whose children have cerebral palsy, HIE, and other health issues associated with a birth injury.


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