Apgar Scores and Their Timing: What the One-, Five- and Ten-Minute Entries Show in an Illinois Birth Record

Few moments in medicine are watched as closely as the first minutes after birth. In that short window a delivery team checks breathing, heart rate, color, tone, and reflexes again and again. Those same minutes are also some of the hardest to piece together later, because everyone in the room was looking at the baby, not the chart.

Even so, the record holds a great deal. The Apgar score, a simple zero-to-ten scale entered at set intervals after delivery, is one of the most visible entries in a birth chart, and it is often the first number families notice when they request records.

We understand that reading a birth record after a difficult delivery can be painful, especially when the numbers on the page do not match what a family remembers from the room. This guide explains what the one-, five- and ten-minute Apgar entries show and why the timing of each one matters.

It also covers how attorneys and medical reviewers read those scores alongside resuscitation notes. It is a narrower companion to our broader pages on what happens in the delivery room, and it is meant to help families understand the record, not to diagnose what happened.

Dr. Virginia Apgar, an anesthesiologist, described the score in 1953 as a quick, standard way to report a newborn's condition right after birth. Today the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics still endorse it as a way to report a newborn's status and response to resuscitation.

The score has five parts, and each one is rated zero, one, or two. The five parts are:

• Appearance (Color). Whether the baby is pale or blue all over, pink with blue hands and feet, or pink throughout. Color is often marked down even in healthy newborns, because bluish hands and feet are common in the first minutes.
• Pulse (Heart Rate). Absent, below 100 beats per minute, or 100 and above. Heart rate is the part reviewers watch most closely when a baby needs help breathing.
• Grimace (Reflex Irritability). No response to stimulation, a grimace, or a cry or active pulling away. This part reflects how the nervous system responds in the first minutes.
• Activity (Muscle Tone). Limp, some flexion of the arms and legs, or active motion. Poor tone can point to a baby under stress or affected by medication.
• Respiration. Absent, slow or irregular, or a strong cry. Breathing effort often shapes the rest of the score, because the other signs improve once the baby is breathing well.

The five ratings are added together for a total between zero and ten. Under the joint ACOG and AAP guidance, a score of 7 to 10 is considered reassuring, 4 to 6 moderately abnormal, and 0 to 3 low for a term or late-preterm infant.

The score is assigned by a person, not a machine. Usually a delivery nurse, a neonatal nurse, a pediatric or neonatal clinician, or the obstetric provider records it, and in a busy room the person who assigned the score may not be the one who charted it.

The same guidance also notes that some parts of the score are partly subjective. Prematurity, maternal anesthesia or sedation, and congenital conditions can all lower a score with no delivery-room error involved.

For these reasons, a careful reviewer treats the Apgar score as one data point rather than a conclusion. Its value comes from where it sits in the timeline and what the surrounding notes say.

Each Apgar entry captures a different moment, and the moments do not mean the same thing. The differences are easiest to see one interval at a time.

The one-minute score. This entry reflects how the baby looked at the very start of the transition to life outside the womb. ACOG and the AAP say the score should not be used to decide whether to start resuscitation, because drying, warming, stimulating, and supporting breathing should begin before the one-minute mark if the baby needs them.

A low one-minute score on its own therefore says relatively little about long-term outcome. It may reflect conditions during labor, medications, or a hard delivery, and many babies with low one-minute scores recover quickly.

The five-minute score. This entry carries more weight. It shows how the baby responded to the first minutes of care, whether that care was routine or involved active resuscitation.

The change between the one- and five-minute scores is often as telling as either number. A score that climbs from 3 to 8 tells a very different story than one that stays at 3 or drops.

The ten-minute entry and beyond. Under the joint ACOG and AAP guidance, when the five-minute score is less than 7, more scores should be assigned every 5 minutes up to 20 minutes. Ten-minute entries therefore show up in charts where a baby was still struggling at five minutes.

If a five-minute score was low and no later scores appear, the gap is worth noting. A missing entry does not prove anything by itself, but it shapes the questions a reviewer asks next.

ACOG's 2014 report on neonatal encephalopathy lists an Apgar score below 5 at both five and ten minutes as one of several findings consistent with an acute event around the time of delivery. It is one factor among many: cord blood gases, brain imaging, and the clinical course all count, as our page on HIE and oxygen deprivation explains.

Taken together, the intervals read as a short timeline:

• One minute. The baby's condition at the start of transition, often shaped by labor and delivery.
• Five minutes. The baby's response to the first minutes of care, and the main trigger for further scoring.
• Ten minutes and later. Ongoing status when a baby has not recovered, and often the entries most closely tied to questions about oxygen deprivation.

An Apgar timeline shows how a newborn's condition changed from minute to minute. What it cannot show on its own is why.

Apgar scores rarely tell the full story alone. They gain meaning from the records around them, including the resuscitation record, the delivery note, and the neonatal team's admission note.

The expanded Apgar form. ACOG and the AAP encourage an expanded reporting form that records, minute by minute, which interventions were in place when each score was assigned. Those interventions include supplemental oxygen, positive-pressure ventilation, CPAP, intubation, chest compressions, and epinephrine.

This matters because a score of 6 for a baby breathing on their own is different from a score of 6 for a baby on assisted ventilation. As the joint guidance explains, a score assigned during resuscitation is not equivalent to a score assigned to a baby who is breathing without help.

When reviewers set the Apgar entries next to the resuscitation notes, they usually look for:

• Time of birth and clock source. Whether the delivery time came from a wall clock, a warmer timer, or a monitor, and whether later entries use the same clock. A few minutes of drift between clocks can change how the entire sequence reads.
• Who was present and when. When a neonatal or resuscitation team was called and when it arrived, compared with the minute markers on the Apgar form. The delivery note and nursing record often give separate times that have to be reconciled.
• Interventions versus scores. Whether the resuscitation record shows ventilation or compressions at a minute when the Apgar entry describes a vigorous baby, or the reverse. Mismatches like this are among the most closely examined details in a delivery-room review.
• Heart rate trend. Whether the recorded heart rates match the pulse rating in each score. Under the Neonatal Resuscitation Program, a rising heart rate is the primary sign that ventilation is working.
• Late entries and edits. Whether scores were entered or changed after the fact. An electronic health record's audit trail can often show when each entry was made and by whom.

Discrepancies do not by themselves prove a deviation from the standard of care. A mismatch between the score and the notes is, however, often where a closer review begins.

Reviewers also read the Apgar entries next to the cord blood gas results, which give an objective measure of the baby's acid-base status at birth. A low five-minute score with severe metabolic acidosis reads very differently from a low score with normal gases.

The Apgar story also begins before delivery. The fetal heart rate tracing and the timing of any delayed emergency C-section can help explain why a baby arrived in the condition the scores describe.

After delivery, the placental pathology report can add another independent view of what happened before birth. A review that treats all of these records as one timeline is far more reliable than one that reads any single number alone.

In an Illinois medical negligence case, a claimant must ultimately prove the core elements. A provider owed a duty of care, the provider deviated from the standard of care, and the deviation caused the child's injury.

Apgar documentation can bear on causation and timing, but it rarely proves either element alone. Whether a particular delivery-room decision caused a particular injury is something a case must prove through expert analysis, not something a score settles.

Before a case is filed, Illinois law requires the plaintiff's attorney to file an affidavit stating that a qualified health professional has reviewed the case, together with that professional's written report, under 735 ILCS 5/2-622. That reviewer will typically examine the Apgar entries, the resuscitation record, and the neonatal course in deciding whether there is a reasonable and meritorious basis for the claim.

How long a family has to bring a claim is a separate question, and the answer depends on the facts. Illinois has distinct limitations and repose provisions in 735 ILCS 5/13-212, and the analysis can differ for the child's own claim, a parent's claim, and the repose period.

Because of those differences, families should confirm their timeline with counsel rather than rely on a general rule. Our guide to bringing a claim in Illinois walks through how these provisions are usually analyzed.

The evidence, on the other hand, is time-sensitive. Electronic audit trails, monitor data, resuscitation code sheets, and the placenta itself can become harder to recover over time, which is why counsel often requests complete records, including metadata, early in a review.

Questions a review may look at include, but are not limited to:

• Team activation. Whether the resuscitation team was called in time given what the fetal tracing showed before delivery.
• Start of ventilation. Whether breathing support began promptly once the baby was not breathing effectively.
• Completeness of scoring. Whether the expanded form and the ten-minute and later entries were completed when the five-minute score called for them.
• The neonatal course. Whether care after the delivery room, including decisions about therapeutic cooling, followed accepted guidance, a subject covered in our page on NICU negligence.

These questions help connect the first minutes of life to the diagnoses that may come later, such as cerebral palsy. Whether that connection holds in a given case is exactly what expert review is meant to test.

Families who request a birth record often find that the newborn's Apgar scores sit in one place, the resuscitation notes in another, and the NICU admission note somewhere else entirely. Gathering the full set is the first practical step toward understanding what happened.

Records that are usually worth requesting include:

• The maternal chart. Labor notes, medication records, and the delivery note, including the recorded time of birth.
• The newborn chart. The Apgar form, the resuscitation or code record, and the nursing newborn assessment.
• Neonatal records. The NICU admission note, cord blood gas results, and any imaging or cooling-therapy documentation.
• Monitoring data and metadata. Fetal monitoring strips and the electronic audit trail showing when each entry was made and edited.

It can also help for parents to write down what they remember about the timeline while it is still fresh. Recollections such as when a team arrived, or when the baby first cried, can be compared against the chart during a review.

Our Chicago birth injury attorneys work with independent physicians, neonatologists, and nurse reviewers to reconstruct the first minutes after delivery from every available record. We know these reviews are about a family's child, not a set of numbers, and we approach them with that in mind.

If questions about the delivery room remain unanswered, we welcome the opportunity to review the record with a family and help them understand the next steps. Free consultation. No fee unless we recover.

This article is for informational purposes and does not constitute legal or medical advice. Consult a qualified attorney licensed in Illinois and a licensed clinician about your specific situation.