Apgar Scores & Birth Injuries

Understand when a low Apgar score could be a sign of medical negligence

New parents are often surprised to discover that their newborn receives their very first test in life within moments of entering the world. While you might be busy gazing in wonder at your little one’s beautiful features, the doctors and nurses are actively gauging several important characteristics that give a glimpse into their overall well-being.

Knowing what an Apgar score means helps you to understand what your care team is talking about when they give you an update on your newborn’s health status, and you’ll be better prepared to address the potential reasons why your baby might receive a low score.

Who created the Apgar score?

The Apgar scoring system was first developed and used in 1953 by Dr. Virginia Apgar. At the time, she was serving as the director of obstetric anesthesia at Presbyterian Hospital, and there weren’t any formal protocols regarding when or how to provide medical intervention to infants who experienced respiratory distress and other concerning issues shortly after birth.

As a leader in her field, Dr. Apgar created the scoring system as a response to a student’s question regarding what they should be looking for when they provide a newborn with a visual exam.

After presenting the scoring system to her colleagues in a national anesthesiology meeting, it was published in a complete manuscript in 1953. Shortly after its publication, the score became used throughout the healthcare profession to identify newborns who were in need of intensive medical assistance.

How is the Apgar score performed, and what does it measure?

What does my baby’s Apgar score mean?

Each of these characteristics is given a score from 0 to 2. Then, each element is added up to determine the final Apgar score. The maximum possible score is a 10, while the lowest possible score is a 0.

Most babies won’t receive a perfect 10 because, frequently, a newborn’s hands and feet stay slightly bluish until they get warm, and there are still some inconsistencies regarding the scoring system on the higher level. For instance, the frequency of perfect 10 scores can range from 8.8% to 92.7% in different countries.

If the baby’s score does not improve between the first test at 1 minute after birth and the second test 5 minutes after birth, the doctors and nurses should continue to monitor the baby and give the baby any necessary medical care.

If you aren’t sure if your baby has suffered a birth injury, contact us. We will do a free case review to help you determine whether your child was injured by negligence.

What is the biggest impact of using the Apgar score test?

While the difference between a score of 9 and 10 might seem minimal, the real impact of the Apgar test is noticeable when one takes a look at how the lower-scoring infants face a higher risk of mortality.

During her studies, Dr. Apgar found that infants who had scores in the 0 to 2 point range had a neonatal mortality rate of 14%. Compared to a mortality rate of only 0.13% for those who had scores within the range of 8 to 10, it became clear that focusing on providing the low-scoring infants with prompt and intensive medical care could improve their chances of surviving beyond the first month of life.

Today, these findings still hold true, and using the scoring system has helped to save countless newborns’ lives over the years.

What causes a low Apgar score?

If your baby has a low Apgar score, which is defined as 6 or below, they may have signs such as a slow heart rate or no heart rate, weak breathing or no breathing, little flexion or no muscle tone, little to no response to stimulation, and little to no color, which means poor blood flow or circulation.

These signs are obviously cause for concern, and medical staff will respond accordingly. The causes of these signs can vary, but the most common causes of these signs include:

• Oxygen deprivation. This means that your baby’s brain is not getting enough oxygen or, in some cases, may be completely deprived of it. Brain damage can result depending on the extent and length of deprivation your baby has experienced.
• HIE. When a baby’s brain is deprived of oxygen, their brain cells can become injured. If your baby is suffering from HIE, medical staff may proceed with infant cooling, which is a multiple-day process that will slow down and prevent damage to their brain cells.
• Cerebral palsy. Treatment is out there for cerebral palsy, which is a condition affecting your baby’s physical abilities. This congenital condition can last anywhere from a few years to a lifetime. It can be inherited through genes.

These causes have different treatment options, responses, and effects on your baby’s long-term well-being.

A low Apgar score is often associated with difficult birthing experiences. Babies who are from a high-risk pregnancy or a premature birth tend to have lower Apgar scores. Prolonged deliveries and delayed cesarean sections (C-sections) can lead to fetal distress, which is noticeable in the characteristics that the Apgar score measures in the first few minutes after birth.

Although issues such as poor respiration might resolve later on, there is a chance that they could have long-term implications for the baby’s future development.