Science history: Virginia Apgar and the score you didn’t know you had


Simple system made a major contribution to assessing the health of newborns. Jeff Glorfeld reports.


Virginia Apgar in 1973.

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Millions of people around the world have been rated on a scale from zero to 10, and they know nothing about it. They received this score one minute after their birth, and again five minutes later. It has nothing to do with how pretty they might be.

It’s called an Apgar Score, a system devised to help evaluate a newborn’s condition at birth, and of the need for immediate attention. He or she is evaluated based on five variables: heart rate, respiratory effort, muscle tone, reflex irritability, and colour.

Virginia Apgar, a physician and anaesthesiologist, developed the system in 1952.

In 2015, in an article in the journal Anesthesia & Analgesia, Selma Calmes calls it “one of the most important contributions of anesthesiology to medical practice”.

In an earlier article in The Journal of Perinatal Education, Kirsten Mongomery explains how a numerical score of zero, one or two is assigned in each category for a maximum score of 10.

“Apgar scoring is best used in conjunction with additional evaluative techniques such as physical assessment and vital signs,” she says.

This test is done to determine whether a newborn needs help breathing or is having heart trouble. According to an article produced for the US National Library of Medicine, “the higher the score, the better the baby is doing after birth”.

“A score of seven, eight, or nine is normal and is a sign that the newborn is in good health. A score of 10 is very unusual, since almost all newborns lose one point for blue hands and feet, which is normal for after birth.

“Any score lower than seven is a sign that the baby needs medical attention. The lower the score, the more help the baby needs to adjust outside the mother's womb.”

Most of the time, it adds, “a low score at one minute is near-normal by five minutes”, and “a lower Apgar Score does not mean a child will have serious or long-term health problems. The Apgar Score is not designed to predict the future health of the child”.

Apgar was born in in Westfield, New Jersey, on 7 June 1909. A program produced for the Public Broadcasting System, “They Made America”, describes how, in 1933, she became one of the first women to graduate from Columbia University with a medical degree.

Selma Calmes recounts how Apgar came up with her idea while at breakfast in the Columbia University hospital cafeteria.

“One day, a medical student remarked at breakfast about the need to evaluate newborns. Apgar said, ‘That’s easy, you’d do it like this’.” With that, “she scribbled down the five points of the Apgar Score” on a scrap of paper, then “dashed off to the labour and delivery suite to try it out”.

Another article in the US National Library of Medicine, “Changing the Face of Medicine”, says the score was presented in 1952 at a scientific meeting, and first published in 1953. “Despite initial resistance, the score was eventually accepted and is now used throughout the world.”

The article describes how Apgar went on to relate the score more closely to the effects of labour, delivery, and maternal anesthetics on the baby's condition.

“Colleagues Dr Duncan Holaday and Dr Stanley James helped her make these connections, providing new methods of measuring blood gases and blood levels of anesthesia, and contributing specialised knowledge in cardiology.

“Together, they were able to demonstrate that babies with low levels of blood oxygen and highly acidic blood had low Apgar Scores and that giving cyclopropane anesthesia to the mother was likely to result in an infant's low Apgar Score.

“Finally, the Collaborative Project, a 12-institution study involving 17,221 babies, established that the Apgar Score, especially the five-minute score, can predict neonatal survival and neurological development.”

Virginia Apgar died in New York on 7 August 1974.

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Jeff Glorfeld is a former senior editor of The Age newspaper in Australia, and is now a freelance journalist based in California, US.
  1. https://pediatrics.aappublications.org/content/136/4/819
  2. https://journals.lww.com/anesthesia-analgesia/Fulltext/2015/05000/Dr__Virginia_Apgar_and_the_Apgar_Score___How_the.23.aspx
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595023/
  4. https://profiles.nlm.nih.gov/CP/
  5. https://cfmedicine.nlm.nih.gov/physicians/biography_12.html
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