What is the Newborn Apgar Test?

Understanding the Apgar test

Since 1952, all babies have entered the world to be anxiously greeted by their parents and…a test. The Apgar test was developed by obstetric anesthesiologist, Virginia Apgar, as a way to quickly assess the status of a newborn’s transition from fetal life to the outside world. Obstetricians and midwives use this method as a way to capture a brief glance into a newborn’s general state in intervals of one minute, five minutes, and ten minutes after birth to determine if immediate medical intervention is needed.

What Does “Apgar” Refer To?

The term Apgar stands for:

  • Appearance (skin color: is baby’s skin pinkish or blueish?)
  • Pulse (heart rate: is the baby’s heart rate >100 beats per minute?)
  • Grimace response (reflexes: is baby responsive to airway stimulation?)
  • Activity (muscle tone: is baby limp or active?)
  • Respiration (breathing rate and effort: is baby crying?)

Each of these five categories is scored on a scale of 0 to 2, with 0 being the lowest and two being the highest score to total a perfect score of 10.

What Does the Apgar Score Mean?

At the initial one-minute APGAR, babies who score between a seven and ten will usually undergo standard, post-delivery care. Babies who score between four and six may need additional breathing assistance. Generally, babies who score less than four require rapid, lifesaving measures.

At the subsequent five-minute APGAR, a score of seven to ten is considered normal. If the score falls below a seven after the minute interval period, the baby will need to continue with monitoring every five minutes for up to twenty minutes.

An Apgar score that remains 0 beyond the ten-minute time frame determines whether continued resuscitative efforts are required. Studies have found that very few infants with an Apgar score of 0 at ten minutes have been reported to survive without some degree of neurological impact.

What Happens If My Baby Has a Low Apgar Score?

A low Apgar score at one minute does not need to cause unnecessary alarm. Sometimes, a slightly lower score is common among babies born after a complicated labor and delivery, high-risk pregnancy, C-section, or prematurely. One article confirms the fact that a low Apgar score does not mean that asphyxia has occurred, or that it will cause neurological and cognitive problems later in life. However, a low score at the five-minute mark indicates an increased likelihood of disability.

Similar research findings reveal that a severely low Apgar score at five minutes is associated with an increased risk of neonatal brain damage, cerebral palsy (CP), and learning difficulties among the spectrum. Furthermore, the study revealed that infants with moderate neonatal encephalopathy who don’t develop cerebral palsy have a chance of developing some degree of cognitive impairment in their teenage years. Other complications associated with low Apgar scores can include higher rates of bradycardia (slow heart rate), pneumothoraxes (abnormal air between lungs and chest wall), acidosis (excess acid buildup), and increased oxygen requirement during the first 6 to 8 hours of life.

Another prevalent issue observed among newborns with low Apgar scores is hypoxic-ischemic brain injury (HIE). A study done of 142 newborns diagnosed with perinatal asphyxia were reviewed over a one-year period. Of these newborns, 62% had a one-minute Apgar score of four or five, and the majority scored a six or higher at the five-minute test. Among these children, there were 65 cases of hypoxic-ischemic brain injury, with severity correlating with lower Apgar scores.

How Can Umbilical Cord Stem Cells Play a Role?

Cord blood stem cells are used to treat a wide array of conditions that include certain leukemias, lymphomas, inherited red cell abnormalities, immune system disorders, and other inherited metabolic disorders. In fact, cord blood stem cells have proven to be beneficial in the treatment of nearly 80 diseases, and as research continues to advance, stem cells will become a treatment for more conditions.

Clinical research is uncovering the fact that mesenchymal stem cells (MSCs) derived from human umbilical cord blood and tissue possess optimal characteristics for neural therapy. Studies have found that the properties in umbilical cord stem cells (potentially both the hemopoietic stem cells and the MSCs) are capable of replacing dying cells and releasing neurotrophic factors that restore damaged tissue. There are several clinical trials taking place to explore umbilical cord stems cells for the treatment of cerebral palsy, autism, Alzheimer’s, and other neurological conditions.  

One such study conducted by Duke, under the direction of our medical director, Dr. Joanne Kurtzberg, revealed that an infusion of a child’s own umbilical cord blood improved brain connectivity and motor function in children with spastic cerebral palsy. In addition to positive clinical trial outcomes for cerebral palsy and autism, current studies are taking place to test the efficacy of cord blood to treat congenital hydrocephalus, traumatic brain injury, ischemic stroke, global developmental delay, and ataxia.

We can help give your baby a boost

What is Cryo-Cell’s Baby Boost Program?

Cryo-Cell International and hospitals throughout the U.S. are working together to aid newborns and their families who may be at risk for developing neurological disabilities based on a low Apgar score. Our program offers qualifying babies who receive a low Apgar score the possibility to bank their cord blood stem cells free of cost for the first three years.

If a child has an Apgar score of 3 or below at one minute, the labor and delivery nurses will collect the cord blood using a Cryo-Cell collection kit. If the score is still a three or below at five minutes or if there has been medical intervention (resuscitation), the baby will qualify for free cord blood processing and three free years of storage. The doctor or delivering nurse will notate on the collection kit documents the reason for collection. Often, the collection will have taken place based on a low one-minute Apgar score, but the score will have risen to normal levels at five minutes. In this scenario, parents will have the option to call and enroll or discard the collection. If the cord blood stem cells have not been used within three years, the family has the option to continue storing and will be responsible for the annual storage fee.


Regardless of your baby’s score, it’s important to understand that the Apgar assessment was designed to help doctors discern a newborn’s overall physical condition to make a rapid-fire decision on whether additional medical care is needed. In no way does it predict your baby’s long-term health, behavior, or intelligence. Your doctor will determine the best course of action based upon the score at each testing interval. Whether your child scores high or low, know that there are resources available to help you and your baby get off to the best possible start. Tests aren’t always easy, but one bad score does not dictate the course of your child’s life in the classroom or the delivery room.

Last Updated on: 10/03/2023 by Diane Paradise