Objective: To correlate the Apgar score, and neonatal mortality andits causes at a hospital located in the southern area of São Paulo City. Methods: A retrospective study performed by analysis of medicalcharts (n=7,094) of all live newborns during the period of 2005 to2009, with data up to 28 days of life in reference to weight, Apgarscore, survival and cause of mortality. Cases were analyzed by theX² test (p < 0.05). Results: In 7,094 births, there were 139 deaths,58.3% during the first week, and 3.6% of them with Apgar < 4 inthe 1st minute. A positive association was found between mortalityand this variable, with significantly declining values up to 2,000 gin weight. In the group with weight < 1,000 g, the association withApgar < 4 in the 1st minute with mortality was three-fold greaterthan in the 1,000-1,500 g weight group, and 35-fold greater than inthe ≥ 3,000 g group. Among newborns with Apgar 8-10, the rate ofmortality and low weight was two times greater than in those withweight > 2,499 g. Fetal distress and prematurity were associated withearly neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. Conclusions: The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.