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Jonathan Rosenfeld

March 2, 2023

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Were you or your unborn baby the victim of medical negligence that led to a birth injury? Did the obstetrician make an error when reviewing your baby’s Apgar score and neglect to give immediate medical care or emergency assistance to your infant?

No parent should endure the emotional and financial burden of raising a child with severe developmental or neurological disorders.


The birth injury attorneys at Rosenfeld Injury Lawyers handle medical negligence cases. They can serve as your legal advocates to secure the maximum compensation you need to provide for your baby’s health and care.

Call our personal injury attorneys today at (888) 424-5757 (toll-free phone call) or use the contact form to schedule a free case evaluation to discuss your newborn’s birth injury.

What Does an Apgar Score Mean?

Since 1952, doctors have used Apgar scores to check whether newborns required resuscitation after their mother received anesthesia during the birthing process. Before, the Apgar score test was used by healthcare providers to predict newborn survival rate and neurological problems or to diagnose asphyxia after birth.

Doctors use the Apgar score to quickly assess a newborn child’s health soon after birth to determine if emergency care is needed. The first test is performed within the first minute, sometimes before newborns have had their first strong cry.

After the one-minute test, medical professionals will perform a second test 5 minutes after birth on babies with a low score whose arms and legs are blue or when the baby is not breathing. Some babies with a low score may require oxygen after clearing out the airway to assist in breathing.

Low and High Scores

A slightly low score in the first one-minute test is standard, especially in complicated labor. Often the score test is taken twice in the first few minutes, at one and five minutes, or more if there is no response to stimulation.

The remaining low Apgar scores indicate that the child may have suffered birth injuries and needs close monitoring and immediate medical care. Lower scores require more intense medical intervention.

Physical stimulation can also help to ensure that the baby’s breathing rate and effort are healthy. Most babies with a lower baby score will not necessarily develop severe other concerns that compromise the baby’s long-term health.

The highest Apgar score is a 10, but few babies get this as most babies’ hands, and feet remain blue until a few minutes after birth. In some cases, score assessments are the direct result of the actions taken by the medical team during childbirth.

What Does the Apgar Score Measure?

Apgar stands for appearance, grimace, pulse, activity, and respiration and measures these physical conditions within the first few minutes after childbirth. Within the first minute of a child’s life, they are evaluated in five categories according to rate and effort. They may receive a score as high as ten or as low as zero.

Perfectly healthy babies will receive a score at or near ten. If the baby has a low score, he will require medical care such as resuscitation and should be monitored for other signs of distress.

The Apgar test scores are then retaken at five minutes. If the infant still has a low score, the doctors may re-evaluate the newborn every five minutes to quickly decide on the recommended medical care.

The Apgar Score System

According to the American Academy of Pediatrics, the Apgar score provides a helpful shorthand for reporting a newborn infant’s status and whether they require immediate medical care or emergency assistance.

The Apgar scoring system created by anesthesiologist Virginia Apgar involves a quick test performed one minute after birth, based on an overall score of 1 to 10. The highest score refers to the newborn infant doing better in the first minute after birth. Then, a second quick test is performed five minutes after birth.

A baby’s score based on five criteria ranging between seven and nine is expected, meaning that the baby is normally in good health and functioning. A lower than usual score often indicates a greater risk for neonatal mortality based on one or numerous factors, including most babies born with cesarean section fluid in the airway due to a difficult birth.

One-Minute Apgar Scores

The one-minute Apgar score refers to how well the newborn tolerated the delivery process and showed the need for immediate medical care. The following dangers are checked:

  • Breathing rate and effort at respiration
  • Muscle tone – no or little movement
  • Baby’s heart rate – slow, irregular or normal rate
  • The normal skin color – not bluish-gray or pale over baby’s entire body, especially hands and feet,
  • Reflexes – Grimacing with a weak cry, absent

Two-Minute Apgar Scores

The baby’s score from the second test performed 5 minutes after birth reveals how well the newborn baby thrives outside the mother’s womb. The normal color of hands and feet, if the baby pulls away, sneezes, coughs, or cries, and the breathing rate, effort, and heartbeat are rechecked.

In some cases, the health care providers will obtain a further 10-minute score after the baby is born to monitor the baby’s condition. Physicians expect lower scores for premature babies and newborn infants born through a Cesarean section.

Five Factors of the Apgar Score

The medical staff can perform testing to examine the newborn’s condition involving breathing and other signs. There are five factors or criteria that the Apgar test is tallied on to check if the baby is perfectly healthy or if emergency care is needed.

Testers score through observation on a scale of 0, to 2, with 2 being the best score. Scores help identify a birth injury, trauma, or adverse neurological outcome during the birthing process.

An average or best score for a normal rate and normal color usually indicates a baby is in good health and does not suffer any health complications.

Factor 1 – Reflex Irritability and Grimace Response

  • No reaction to active motion reflexes or airways stimulation (0)
  • Grimacing – with stimulation absent, but with a weak cry (1)
  • Grimacing (response to stimulation), pulls away, sneezes, coughs, or cries vigorously (2)

Factor 2 – Activity Muscle Tone

  • Muscle tone is limp, floppy, and loose with some bending (flexion) of the arms and legs (0)
  • Minimally active muscle tone or little movement (1)
  • Active muscle tone and motion (2)

Factor 3 – Heart Rate

  • No heartbeat heard on the stethoscope (0)
  • Heartbeats less than 100 beats per minute (1)
  • Heartbeats higher than 100 beats per minute (2)

Factor 4 – Respiratory Effort

  • Not breathing (0)
  • Slow or irregular breathing rate (1)
  • Crying well with normal respiration, breathing rate, and effort (2)

Factor 5 – Skin Color

  • Bluish gray or pale skin (0)
  • Pink skin color where hands and feet remain blue (1)
  • The entire body is pink, a normal color (2)

What Does a Low Apgar Score Mean?

When a doctor observes a baby’s score at three or below, the test results might indicate severe health issues requiring immediate medical intervention. Doctors and nurses perform follow-up testing for babies with low scores at five-minute intervals to determine the baby’s progress in the minutes after birth.

Sometimes, increased oxygen saturation can help with slow or irregular breathing to improve the baby’s score, with the skin then appearing rosier as the heartbeat and respiration are normalized.

Low scores are consistent with high newborn infant mortality rates and other concerns such as severe childbirth injuries, developmental or neurological problems, brain injury, and cerebral palsy.

While medical staff refers to the test to analyze the newborn’s condition, it is not a predictor or indicator of many babies’ future health and physical condition.

When Should I Talk to an Attorney About a Low Apgar Test Score?

Did your child receive a low Apgar score and is suffering from childbirth injuries with lifelong implications? Did your doctor neglect to give you specific medical advice regarding your infant’s score? Speak with a birth injury lawyer who can investigate the matter further for signs of medical negligence or malpractice.

A birth injury lawyer can review the vital information about your baby’s health in their medical records that might explain what happened and see if the doctors and nurses upheld the professional standard of healthcare.

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Call our law office today at (888) 424-5757 to schedule a free initial consultation to learn more about your legal options, our legal services, and what you can expect from the process. All confidential or sensitive information you share remains private through an attorney-client relationship.

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Jonathan Rosenfeld was professionally objective, timely, and knowledgeable. Also, his advice was extremely effective regarding my case. In addition, Jonathan was understanding and patient pertaining to any of my questions or concerns. I was very happy with the end result and I highly recommend Jonathan Rosenfeld.

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Jonathan helped my family heal and get compensation after our child was suffered a life threatening injury at daycare. He was sympathetic and in constant contact with us letting us know all he knew every step of the way. We were so blessed to find Jonathan!

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This lawyer really helped me get compensation for my motorcycle accident case. I know there is no way that I could have gotten anywhere near the amount that Mr. Rosenfeld was able to get to settle my case. Thank you.

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Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial.

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