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Apgar

Newborn Scoring System

Virginia Apgar was a trailblazer: one of Columbia University's first female M.D.s (1933), and one of the first American women to specialize in surgery. Frustrated by chauvinism during her internship, Apgar changed her focus to anesthesiology, which became a specific and separate medical discipline thanks to her. In 1949, she became Columbia's first-ever full Professor of Anesthesiology.

Apgar's research on anesthesia and childbirth led her to her greatest innovation: the Newborn Scoring System---better known as the "Apgar Score"---for assessing the health of newborn infants, which she conceived in 1949, refined, and finally published in 1953. Up until that time, babies at birth were assumed to be in good health unless they exhibited some obvious difficulty or defect: needless to say, internal deficiencies (e.g., circulatory or respiratory) could be missed, resulting all too often in death. Because Apgar realized that "Birth is the most hazardous time of life," she created a system for quickly and accurately assessing a baby's health in the crucial minutes after birth.

Apgar's system assigns a maximum score of 2 points each for 5 criteria: respiratory effort, reflex irritability, muscle tone, heart rate, and color. The assessment is made at one and five minutes after birth (at fifteen minutes for babies born by cesarean section). A perfect score of 10 and 10 is rare in practice; but a score of at least 7 and 7 virtually guarantees a newborn's health. A lower score alerts obstetricians to the possibility of latent problems (e.g., hemorrhaging, asphyxia), which can then, if necessary, be detected and treated on the spot. Apgar's diagnostic regimen has saved countless lives, and has long been a standard worldwide. The compliment of one famous physician holds true: "Every baby born in a modern hospital anywhere in the world is looked at first through the eyes of Virginia Apgar."

In 1959, Apgar was appointed Director of the March of Dimes. In that capacity, she continued her energetic efforts to improve the healthcare of infants and children. By the time of her death in 1974, Virginia Apgar was admired for her great contributions to society as well as to science.

[May 1997]

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