Abstract. Aims: To assess the perinatal results of newborns with a zero Apgar score at the first minute of life. Methods: Case-control study conducted over a period of 10 years. We assessed maternal, fetal, and neonatal variables. Data were analyzed using SPSS 19.0. Results: Of the 15,616 births occurring during the study period, 29 (0.2%) had a zero Apgar score at the first minute of life (Group I). A control group comprised three newborns with Apgar scores greater than zero for each case (Group II). Comparing cases (Group I) and controls (Group II) showed a higher rate of cesarean deliveries (69% vs. 46.7%; p < 0.05), younger gestational age (34.8±5.5 years vs. 38.5±2.5 years; p < 0.0001), higher incidence of hemorrhagic amniotic fluid (27.6% vs. 17.2%; p < 0.0001), lower fetal weight (2,307±958 g vs. 3,069±609 g; p < 0.0001), lower fifth-minute Apgar score (2.5±2.0 vs. 8.9±0.7; p < 0.0001), lower pH of the umbilical artery (7.01±0.21 vs. 7.21±0.08; p < 0.0001), need for neonatal intensive care unit (100% vs. 20.7%; p < 0.0001), and early neonatal mortality rate (n = 12, 41.4% vs. n = 0). Conclusion: The perinatal assessment of newborns with zero Apgar score in the first minute of life showed a higher rate of operative deliveries and preterm fetuses with low birth weight than in control infants. The higher need for neonatal intensive care therapy is associated with more significant fetal acidosis and apparent death.