What is an APGAR Score and Why is it Important?

An APGAR score is one of the first measures of your newborn infant’s health and well-being immediately after birth. The APGAR score is an evaluation of your newborn’s health that is done in the first minute, 5 minutes after birth, and 10 minutes after birth. The APGAR score is a simple yet vital tool to assess the overall health of a baby after birth and is used to determine whether a newborn needs neonatal resuscitation or medical intervention. By closely monitoring key health indicators like muscle tone, reflex irritability, breathing effort, and baby’s heart rate, doctors can ensure prompt, appropriate care to give the baby the best possible start.


0 Points 1 Point 2 Points Total Points
(skin color)
Blue, pale Body pink,
extremities blue
Completely pink
Pulse Absent Below 100 bpm Over 100 bpm
(reflex irritability)
Flaccid Some flexion of
Active motion
(sneeze, cough,
pull away)
(muscle tone)
Absent Arms and legs flexed Active movement
Respiration Absent Slow, irregular Vigorous cry

Each newborn infant is given an APGAR score of 0-2 for each of the categories (Activity, Pulse, Grimace, Appearance, Respiration) indicated in the chart above. The scores in each category are then added together, for a total score. To avoid poor neurologic outcomes, the baby’s APGAR scores are checked a few times: the first APGAR score is rated right after the birth, then a 5-minute APGAR score and a 10-minute APGAR score. A lower APGAR score of 0-3 indicates that a newborn infant has experienced a potential complication or injury during delivery and needs immediate medical intervention and neonatal resuscitation. If an infant scores 4-6 points, it indicates that the baby’s airway has experienced respiratory depression which raises certain respiratory or cardiac concerns. In this case, a newborn infant needs medical attention and monitoring, but may not be in immediate danger. APGAR score of 7-10 generally indicates good health and oxygen levels.

APGAR scores are not determinative of a newborn infants’ health and are not used to diagnose birth injuries. Instead, APGAR scores are a general indication of the newborn’s state immediately after birth, whether the newborn requires urgent medical attention and the speed at which a newborn recovers from respiratory depression. While not diagnostic of birth injuries or predictive of future health outcomes, low APGAR score may correlate to a birth injury and can be used as important evidence in a medical malpractice action.

APGAR Score and Oxygen Deprivation

Respiratory score, documented minutes after birth on a newborn’s birth record, can form part of the evidence used in medical malpractice claims regarding birth injuries and obstetrical negligence. In instances where a newborn experiences a birth injury caused by oxygen deprivation during delivery, such as fetal asphyxia or hypoxic-ischemic encephalopathy, a low APGAR score serves as evidence they were deprived of oxygen at the time of their birth and should have been delivered sooner.

Newborns who are diagnosed with hypoxic-ischemic encephalopathy or fetal asphyxia have experienced a brain injury due to oxygen deprivation. Medical professionals are responsible for recognizing the signs of fetal distress caused by oxygen deprivation during labour and delivery, and intervening promptly to prevent permanent brain damage. In some cases, the signs of fetal distress may go unrecognized by medical professionals, leading to a failure to intervene and expedite delivery. When the signs of fetal distress are missed, medical professionals may be liable for injuries sustained due to oxygen deprivation at birth. Newborns who experience oxygen deprivation or other complications during delivery will typically display low APGAR scores.

APGAR Score as Evidence of Medical Malpractice

In cases of birth injuries caused by oxygen deprivation to the baby, the APGAR score can be an important piece of evidence that may help demonstrate medical negligence. Low APGAR scores often indicate reduced blood flow and oxygen levels to the baby during labour and delivery, but they are not the only evidence considered by courts and medical malpractice lawyers. Other information, such as umbilical cord blood tests, fetal heart rate monitoring, and diagnostic imaging can be used in addition to the APGAR test to determine the cause and mechanism of a birth injury.

In some cases, APGAR scores begin very low at one minute but recover quickly at five minutes and ten minutes. In these cases, the initial low APGAR score typically indicates a shorter period of oxygen deprivation and with prompt intervention and care, these newborns can often recover quickly. In other cases, when low APGAR scores persist at five minutes and beyond, these low scores can be used as evidence that the newborn suffered prolonged oxygen depression or injury during delivery. While low APGAR scores alone do not conclusively prove a birth injury, they do indicate that a newborn experienced elevated stress or potential injury during the birthing process.

APGAR test is not diagnostic of a birth injury and are subjective evaluation. Low APGAR scores on their own do not prove that your child sustained a birth injury, just as high APGAR scores do not prove that your child didn’t sustain a birth injury. APGAR test is just one piece of the puzzle that, when combined with other circumstances and evidence, can help you prove that your child’s birth injury was a result of medical malpractice.

When to Speak to a Medical Malpractice Lawyer

Children born with serious brain injuries due to oxygen deprivation at birth often require ongoing, specialized care and support for the rest of their lives. These birth injuries can have a profound and lifelong impact on the child and their family. If you believe that your child has suffered a birth injury due to medical negligence, it is important to consult with an experienced medical malpractice lawyer. The legal team at BIMMA has extensive expertise in evaluating and litigating birth injury cases. They offer a no-obligation consultation to help you decide if legal action is the right decision for your family.