The role of Apgar scores in birth injury and medical malpractice cases

When a baby is diagnosed with a birth-related brain injury, obstetricians, pediatricians, neonatologists, and pediatric neurologists look at the newborn’s Apgar scores to help figure out what happened.

What are Apgar scores?

Apgar scores have been around for over 70 years.

According to a 2015 committee opinion from the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG), Apgar scores are an accepted and convenient method for reporting a newborn’s status immediately after birth and after any necessary resuscitation.

How Apgar scores are calculated

A physician, midwife, or nurse assigns an Apgar score by assessing five categories. Each category is assigned a score between 0–2, for a maximum score of 10. The higher the score, the better.

Here are the categories (notice the first letters spell “APGAR”):

• Appearance: Skin color

• Pulse: Heart rate

• Grimace: Response or reflex irritability to a mild pinch

• Activity: Muscle tone

• Respiration

Apgar score results

Apgar scores are typically measured and recorded at 1 minute and 5 minutes after birth, and sometimes at 10 minutes.

• The 1-minute score provides insights into how the baby tolerated labor and delivery.

• The 5-minute score provides some evidence of how the baby has adapted to life outside the womb.

• A change between the 1 and 5-minute scores shows the baby’s response to resuscitation efforts.

A score of 7–10 is considered normal. An Apgar score of less than 7 is a sign that the newborn may need medical attention or resuscitation, such as supplemental oxygen, cleaning airway, or help in getting the heart beating properly.

Significance of Apgar scores

When a baby is diagnosed with hypoxic-ischemic encephalopathy (HIE), one of the first things reviewed is the Apgar scores. When the Apgar scores are documented as normal, defendant physicians, nurses, and hospitals contend that the brain injury isn’t a result of poor labor and delivery care.

Although Apgar scores are useful tools, they aren’t necessarily the “be all, end all.” The AAP/ACOG committee opinion discusses how:

• Apgar scoring is subjective

• Resuscitation must be started before the 1-minute Apgar score is assigned

The committee opinion also downplays the predictive effect of a low Apgar score for cerebral palsy.

Investigating HIE

Figuring out the cause of a birth injury requires experience and careful analysis of many different sources of information. Apgar scores are one piece of the forensic puzzle in hypoxic-ischemic encephalopathy cases. Medical, nursing, and legal professionals also consider cord blood gases, the electronic fetal heart tracing pattern, and clinical information to determine the cause of a brain injury.

If you suspect a labor and delivery or birth-related injury, including HIE, occurred in a Texas hospital, contact a top-rated Texas medical malpractice attorney who is experienced in birth injuries for a free strategy session about your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.