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Apgar Scoring: A Measurement of the Baby's Well-Being at Birth


The Apgar score measures critical components of a baby’s health after birth. Created in 1952 by Dr. Virginia Apgar, doctors are tasked with evaluating five areas, each having a score between zero and two. The final score, between zero and ten, is the final measurement. The higher the number, the healthier the baby.

The timing of Apgar scores varies somewhat among obstetricians and hospitals. Typically, the test is performed one minute after birth and repeated at five minutes after birth. If the score is low, it may be repeated, often at ten minutes after birth.

Criteria for Apgar Scores

Medical students use a simple mnemonic device to remember the key components of an Apgar score:

  • Appearance: the skin color is evaluated. If the baby is blue or pale, he will receive a lower score.
  • Pulse: a baby will receive a zero score if there is no pulse; a score of one if the pulse is less than 100; and a score of 2 if the pulse is 100 or more.
  • Grimace: this element measures the baby’s reflexes and responsiveness to stimulation.
  • Activity: representing muscle tone, this element measures the baby’s ability to contract the muscles.
  • Respiration: respiration measures the strength of the baby’s breathing.

Score Interpretation and Relationship to Cerebral Palsy Birth Injuries

Scores of 1 to 3 are critically low; 4-6 are below normal, and 7+ are normal. Apgar scores do not necessarily predict long-term effects; however, the lower the score, the more likely that the child will have some problems after birth. There is a good correlation between critically low scores and neurological disability.

The American College of Obstetricians and Gynecologists argues that a low Apgar score is not indicative of a cerebral palsy diagnosis. Like other test results, Apgar scores are one measure that is useful to clinicians in determining whether a child suffered an event around labor and delivery that caused injury. A 2010 study from Norway, however, indicates that 11% of children with an Apgar score of three or lower (evaluated at 5 minutes) are diagnosed with cerebral palsy before the age of five. The authors noted that, “[g]iven that Apgar score is a measure of vitality shortly after birth, our findings suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality.”

Contact Us

Our lawyers can examine your child’s medical records to determine what his Apgar score was after birth, and whether that score, along with other factors, helps to explain that your child’s cerebral palsy was caused by negligence during labor and delivery. For more information, contact our medical malpractice attorneys at (440) 252-4399, or send us an online message.

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