When your baby is born, the healthcare team will perform a series of tests to evaluate and ensure their well-being and one of the first critical assessments a newborn undergoes is the APGAR score. This simple yet essential test gives doctors and nurses immediate insight into a baby’s condition and can sometimes be the first indicator of potential complications. 

If you’re a parent, it’s important to understand what the APGAR score is and why it matters, not only for your baby’s immediate well-being but also in situations where medical negligence may be a concern.

What is the APGAR Score?

The APGAR score is a quick test performed on a newborn at one minute, five minutes, and 10 minutes after birth. Created by Dr. Virginia Apgar in 1952, the test assesses five critical areas to determine how well your baby is doing immediately after delivery. Each area is given a score between 0 and 2, with a total maximum score of 10. The five areas evaluated are:

• Appearance (Skin Color): This area checks your baby’s skin tone and whether they are getting enough oxygen. A healthy baby’s skin should be pink all over, indicating good circulation and oxygen levels.
• Pulse (Heart Rate): A normal heart rate for a newborn should be above 100 beats per minute. If the heart rate is lower, the baby may need some assistance to stabilize.
• Grimace (Reflex Response): This test measures how your baby responds to stimulation, like a gentle pinch or rub. A baby with a strong reflex will grimace, cough, or cry in response.
• Activity (Muscle Tone): This test evaluates your baby’s muscle movement and strength. Active movement is a good sign that your baby is in good health.
• Respiration (Breathing Rate and Effort): The test also checks your baby’s breathing. Strong cries and regular breathing indicate that your baby’s lungs are functioning well.

Each of these areas is given a score of 0, 1, or 2, and the total score can range from 0 to 10. A higher score generally means the baby is doing well. Anything 6 or below means that immediate medical attention is needed.

How the APGAR Score is Calculated

APGAR Scoring Chart
APGAR Sign	0 Points	1 Point	2 Points
Appearance (Skin Color)	Pale or blue all over	Pink body, but blue extremities	Pink all over
Pulse (Heart Rate)	No heartbeat	Fewer than 100 beats per minute	At least 100 beats per minute
Grimace (Reflex Irritability)	No response to stimulation	Grimace or weak cry when stimulated	Strong cry, cough, or pulls away when stimulated
Activity (Muscle Tone)	Limp, no movement	Some flexing of the arms and legs	Active movement
Respiration (Breathing Effort)	Not breathing	Weak or irregular breathing	Good, strong cry and regular breathing

Below is an overview of how APGAR scores are assigned.

Appearance (Skin Color):

• 0 points: Pale or blue all over
• 1 point: Pink body, but blue extremities
• 2 points: Pink all over

Pulse (Heart Rate):

• 0 points: No heartbeat
• 1 point: Fewer than 100 beats per minute
• 2 points: At least 100 beats per minute

Grimace (Reflex Irritability):

• 0 points: No response to stimulation
• 1 point: Grimace or weak cry when stimulated
• 2 points: Strong cry, cough, or pulls away when stimulated

Activity (Muscle Tone):

• 0 points: Limp, no movement
• 1 point: Some flexing of the arms and legs
• 2 points: Active movement

Respiration (Breathing Effort):

• 0 points: Not breathing
• 1 point: Weak or irregular breathing
• 2 points: Good, strong cry and regular breathing

Once all five categories are evaluated, the scores are added together to give a final APGAR score. A score of 7 to 10 is considered normal, while a score below 6 usually means that the baby requires immediate medical intervention.

What Does the APGAR Score Mean for Your Baby?

The APGAR score provides a snapshot of your baby’s health at birth, but it’s not meant to predict long-term outcomes. A low score doesn’t necessarily mean that your baby will have lasting health issues, nor does a high score guarantee perfect health. The score is simply a tool used by doctors and nurses to determine if your baby needs immediate care.

If your baby scores lower than 7, medical staff will likely step in to provide assistance. This could mean anything from suctioning mucus from the baby’s airways to giving oxygen or other medical interventions. If your baby scores low at the one-minute mark, the test will be repeated at five minutes, and possibly again at ten minutes if needed.

A low score at birth can be concerning, but many babies with low initial scores go on to develop normally. Often, a low APGAR score is simply a result of a difficult or complicated delivery, and the baby may quickly recover with medical support.

What Can Cause a Low APGAR Score?

A low APGAR score can be caused by several factors related to the baby’s condition during birth and the delivery process. 

• Premature Birth: Babies born before 37 weeks of gestation may have underdeveloped lungs and other organs, which can affect their ability to breathe and regulate their heart rate. Premature babies often have lower muscle tone and weaker reflexes, contributing to a lower APGAR score.
• Birth Asphyxia: Birth asphyxia occurs when a baby doesn’t get enough oxygen during labor or delivery. This can happen if the umbilical cord is compressed or twisted, if the placenta separates prematurely, or if the mother’s blood pressure drops. Oxygen deprivation can affect the baby’s heart rate, breathing, and overall vitality, leading to a lower score.
• Difficult or Traumatic Delivery: A long or difficult labor, as well as the use of forceps or vacuum extraction, can result in physical stress for the baby. This can lead to temporary issues such as low heart rate, poor muscle tone, or difficulty breathing, which may lower the APGAR score.
• Infections: If the baby has an infection or develops one in the womb, it may affect their overall condition at birth. Infections like maternal chorioamnionitis (a bacterial infection of the amniotic fluid) can cause breathing problems or heart rate irregularities, contributing to a low score.
• Maternal Complications: Certain conditions affecting the mother during pregnancy or labor, such as preeclampsia, diabetes, or infections, can impact the baby’s health at birth. If these complications lead to oxygen deprivation or fetal distress, the baby may have a lower APGAR score.
• Sedative or Anesthetic Medications: Medications used during labor, such as sedatives or anesthesia, can sometimes affect the baby’s responsiveness at birth. If the baby appears drowsy, has weak reflexes, or shows poor muscle tone, these factors may contribute to a lower score.
• Congenital Conditions: Babies born with congenital heart defects, lung conditions, or other health problems may struggle with breathing, circulation, or muscle tone at birth. These issues can result in a lower APGAR score as the baby adjusts to life outside the womb.
• Meconium Aspiration: In some cases, a baby may pass meconium (their first stool) into the amniotic fluid before or during delivery. If the baby inhales the meconium-stained fluid, it can cause breathing difficulties, leading to a lower score.

Each of these factors may contribute to a low APGAR score, but prompt medical intervention often helps stabilize the baby’s condition. In cases where the score remains low, further evaluation and treatment may be necessary to address the underlying cause.

APGAR Scores and Hypoxic-Ischemic Encephalopathy (HIE)

Low APGAR scores are often seen in infants diagnosed with hypoxic-ischemic encephalopathy (HIE), a form of brain damage caused by insufficient oxygen. HIE can lead to long-term developmental or neurological issues, such as epilepsy and cerebral palsy. Common causes include:

• Abnormal maternal blood pressure
• Fetal heart irregularities
• Placental or uterine injuries
• Complications during labor or delivery
• Oxygen deprivation during pregnancy or birth
• Traumatic birth injuries
• Fetal strokes

If a healthcare provider’s actions, or lack thereof, contributed to your baby’s low APGAR score, it could support a medical malpractice claim. Low scores can be an indicator that your medical care team did not follow the expected standard of care, potentially leading to harm.

It’s important to remember, however, that APGAR scores are only one piece of the puzzle. Even if your child’s score was relatively normal, that doesn’t mean a birth injury didn’t occur. APGAR scores can provide insight into a newborn’s health, but they are not a perfect measure. If your child experienced birth injuries, regardless of their APGAR score, you may still have a valid claim.  If you suspect that medical negligence played a role in your baby’s birth injury, seeking legal advice can help you explore your options.

When Could a Low APGAR Score Be Due to Medical Negligence?

While a low APGAR score can result from natural complications during birth, there are instances when it may be a sign of medical negligence. It’s essential to recognize when a low score could have been avoided with proper medical care. Some situations that may point to malpractice include:

• Delayed Medical Response: If healthcare professionals fail to act quickly when your baby’s APGAR score is low, it can lead to long-term health issues. Immediate interventions like providing oxygen or clearing airways are critical in these moments, and a delay can have serious consequences.
• Failure to Monitor During Labor: Proper fetal monitoring during labor is critical to ensure that the baby is receiving enough oxygen. If doctors or nurses fail to properly monitor or respond to signs of fetal distress, this can contribute to a low APGAR score.
• Improper Delivery Techniques: In cases where forceps or vacuum extraction are used improperly, or if the delivery is rushed without due care, it can result in trauma to the baby. This can lead to a low APGAR score that might have been avoided with better medical handling.
• Failure to Address Maternal Health Conditions: If the mother has certain health conditions such as high blood pressure or gestational diabetes, failure to address these conditions during labor can lead to complications that lower the baby’s APGAR score.

In any of these cases, if medical staff did not follow proper procedures or failed to act according to standard practices, they could be held liable for any harm caused. The APGAR score can be a critical piece of evidence in demonstrating that medical staff failed to meet the expected standard of care.

What Parents Should Do After Receiving a Low APGAR Score

If your baby receives a low APGAR score, the first priority is ensuring they receive proper medical care. Ask questions about what the healthcare team is doing to help and monitor the situation closely. If the situation improves quickly, it’s often a sign that your baby is responding well to treatment.

However, if you notice that the staff is slow to respond, dismissive of your concerns, or fails to offer adequate care, it may be time to consult a medical malpractice attorney. Medical professionals are trained to handle emergencies, and their decisions in the delivery room should reflect that training. If they fail to act in your baby’s best interests, you have the right to seek legal recourse.

How a Michigan Medical Malpractice Lawyer Can Help

If you suspect that medical negligence played a role in your baby’s low APGAR score, taking legal action can help you secure monetary compensation for any future medical needs. Birth injuries can have lifelong effects, and it’s important to hold negligent parties accountable to ensure your child receives the care they need.

When working with a lawyer, you can expect them to investigate the circumstances surrounding your child’s birth. This includes reviewing medical records, interviewing witnesses, and consulting with experts to determine whether the medical staff followed proper procedures. If it’s found that they failed to do so, you could be eligible for compensation for medical bills, future care needs, and other damages. If you’re concerned about the care your baby received or want to learn more about your legal options, reaching out to an experienced attorney is a wise choice. 

Questions? Get a Free Consultation From a Medical Malpractice Lawyer

The APGAR score is an important tool in assessing a newborn’s health, but sometimes complications arise that require a closer look. If you have questions or concerns about your baby’s APGAR score and the care they received during delivery, please contact the birth injury lawyers at LegalGenius PLLC today. We are passionate about fighting for our clients and strive to level the playing field against big insurance companies and corporate healthcare organizations. To schedule your free consultation and case review, fill out our Ask the Genius™ form or call (800) 209-4000 today.