Apgar Score for newborn assessment

Delivery rooms in the early 1950s had no standard way to assess a newborn in the first minute of life, and junior residents with little resuscitation training were often left in charge of the baby. When a resident asked Virginia Apgar, an obstetric anesthesiologist at Presbyterian Hospital in New York, how to assess a newborn quickly, she jotted down five objective signs on the nearest piece of paper.

Her 1953 paper in Current Researches in Anesthesia and Analgesia described scoring those signs one minute after birth: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. Each received 0, 1, or 2 points, for a total of 0 to 10. Full-term babies scoring 7 to 10 had a much better chance of surviving their first month. Apgar advised that someone other than the obstetrician do the scoring, because obstetricians rated their own deliveries several points higher.

Apgar also wanted a common yardstick for comparing obstetric practices, types of maternal pain relief, and resuscitation. In September 1952 she presented a trial on 1,021 infants born at the Sloane Hospital for Women that linked the scores to the method of delivery and to the mother's anesthesia. The score also gave delivery rooms a documented condition at birth against which later outcomes could be compared.

By the early 1960s many hospitals used the score. In 1961 Joseph Butterfield of the University of Colorado wrote to tell Apgar that one of his residents had turned her name into a mnemonic for the five signs: Appearance, Pulse, Grimace, Activity, Respiration. Apgar was delighted, and it caught on.

Others tried scoring at five or ten minutes, but Apgar held that the one-minute score was the most useful, because a newborn's condition can change so fast. Most hospitals now score at one and five minutes. With L. Stanley James and Duncan Holaday, Apgar went on to relate the scores to newborn blood chemistry, labor, and maternal anesthesia.