Apgar scores are a part of virtually every newborn’s labor and delivery care and medical record. The scoring system is been around since the 1950s and is use by obstetricians, labor and delivery nurses, and other healthcare providers to make a quick assessment of the baby’s overall condition in the minutes after birth.
Based on this information, healthcare providers are able to assemble any additional personnel and supplies necessary to support the newborn’s needs. In short, it’s a communication tool with a focus on mobilizing appropriate care.
Adding up an Apgar score
A doctor or nurse assesses the newborn, adding up points in five different areas to assign a score at 1, 5, and 10 minutes after birth. The areas include:
A: Activity/Muscle Tone, 0 points for limp or floppy, 1 point for limbs flexed, 2 points for active movement.
P: Pulse/Heart Rate, 0 points for absent, 1 point for < 100 beats per minute (bpm), 2 points for > 100 bpm
G: Grimace, 0 points for absent, 1 point for facial movement/grimace with stimulation, 2 points for cough or sneeze, cry, and withdrawal of foot with stimulation
A: Appearance, 0 points for blue/bluish-gray, or pale all over, 1 point for body pink but extremities blue, 2 points for pink all over
R: Respiration/Breathing, 0 points are absent, 1 point for regular, weak crying, 2 for good, strong cry
Interpreting an Apgar score
The higher the Apgar score, the better, with a maximum of 10. A score in the range of 7 to 10 is considered normal or reassuring. An Apgar score of 4 to 6 is felt to be moderately abnormal, and the range of 0 to 3 is concerning.
In birth injury or birth-related brain injury (cerebral palsy or hypoxic ischemic encephalopathy/HIE) cases, Apgar scores often have a central role that’s far outside what they were intended to be.
Attorneys defending hospitals, OB/GYN physicians, and labor and delivery nurses often point to a normal Apgar score is indicating that a newborn’s brain injury wasn’t birth-related, but was rather caused by some other unknown factor.
In my experience, Apgar scores are notoriously imprecise. There is a subjective element in the way scores are assigned by the doctor or nurse making observation. This varies by the individual’s training and experience. There is sometimes a significant difference between Apgar scores simultaneously documented by an attending physician compared to a resident physician still in training, an experienced labor and delivery nurse, or an inexperienced nurse.
In addition to this inherent variability, recent studies have shown additional bases for why Apgar scores are an unreliable measure to evaluate a newborn’s future well-being outside the labor and delivery suite.
In 2019, researchers reported in the British Medical Journal that Apgar scores in the so-called reassuring or normal range of 7 to 9 have been shown to have a greater risk of illness or death than babies with a perfect Apgar score of 10. This includes higher risk of infections, breathing problems, brain injury as a result of inadequate oxygen, reduced blood sugar levels, and death.
In my view, this research reinforces the fact that an Apgar score felt to be in the normal or reassuring range doesn’t rule out the possibility of a birth-related brain injury. To determine whether such injuries in Texas newborns were caused by birth or labor and delivery negligence, these cases are best evaluated by a top-rated experienced Houston, Texas medical malpractice lawyer.
