"A Proposal for a New Method of Evaluation of the Newborn Infant"
Virginia Apgar (1953)

URL: http://www.apgarfamily.com/Apgar_Paper.html

SITE SUMMARY: First presented at the joint meeting of the International Anesthesia Research Society and the International College of Anesthetists in September 1952, and then published in Current Researches in Anesthesia and Analgesia (July-August 1953), this paper proposes a multipart method of determining a baby's state of health as soon as possible after birth to quickly detect life-threatening problems and avoid complications. This method, know as the Apgar Score, after the Columbia University Presbyterian Hospital doctor who proposed it, has become a standard test procedure for newborn babies. (The paper is a highlight of the official Dr. Virginia Apgar Web page, a feature of the Apgar Family Web site.)

DISCUSSION QUESTIONS AND ACTIVITIES

1. Identify the five tests Apgar suggested for "simple, clear classification" or "grading" of newborn infants. Explain Score ratings in Dr. Apgar's Paper in connection with fair, good, and poor conditions.
2. If a newborn baby has a no. 2 rating for test no. 1, and a no. 1 rating for test no. 2, what is the baby's condition?
3. How are test descriptions and timing somewhat different on the Apgar Score Chart (1995–1998) from what Apgar stated in her paper? (The url for the Neonatology on the Web site, where this chart is found, is cited in the Related Internet Sites section below.)
4. Today, besides the Apgar Tests, other tests are given to newborns. (See data at the Web sites for the American Academy of Pediatrics' Newborn Screening—Fact Sheets, and Table of Newborn Screening by State; the March of Dimes and American Academy of Pediatrics' Public Health Information Sheet; the Newborn Screening Practitioners Manual; plus Resources and Literature Citation of the Month at Neonatology on the Web. [Their urls are cited in the Related Internet Sites section below.]) Should any tests be given? Which tests do you think are essential, or may not be necessary, and why or why not? Some tests require a baby's heel to be pricked to obtain blood. Another test requires a suction device to be used in a baby's nose. Should these invasive procedures, usually stressful and painful, be done? Why or why not?
5. Should special tests automatically be given if there is a family history of a medical condition? Should parents' religious beliefs be followed always or sometimes, even if a baby's condition seems to require medical attention? Who should judge these situations, and how?
6. Visit the Official Dr. Virginia Apgar Web Page. (Its url is cited in the Related Internet Sites section below.) Note the acronym developed to help people remember Apgar test types at a glance. How does the acronym help one remember? Extra Activity: Make an acronym for someone and something else medical- or health-related. Describe the value of the acronym. Option: Choose a woman and what she has accomplished. (For ideas, see the Web sites: Important Figures in the Health Sciences—Their Lives and Works; Women in the Sciences and Women in Medical Fields; plus other Web sites which have some medical-related entries, such as Astronaut Biographies. These sites' urls are in this book's Appendix B: Science Biographies and Career Sources.)
7. Read the 1998 essay "The First Test! Through the Eyes of Dr. Virginia Apgar," by student Sarah Sellers. (Its url is cited in the Related Internet Sites section below.) See information before paragraph one, then paragraphs eleven and eighteen, and identify what qualifies the comments of young Sellers as worth noting, then suggest what she meant when she wrote "Thank you, Dr. Apgar, for seeing them through your eyes …?" See paragraphs eight, nine, ten, thirteen, and fifteen, then tell how the Apgar Score is similar to, yet different from, early assessments of infants at birth. Why is the Apgar Score better? How is the Score slightly different today?
8. Read paragraphs seven and eight of Seller's article (found as cited in Question/Activity no. 8 above). Why was it especially important, according to Sellers, that Dr. Apgar created the Score, then published it, in the late 1940s and early 1950s? What were the steps Apgar used to create the Score?
9. See paragraphs one and twelve in Seller's article (found as cited in Question/Activity no. 8 above). What, in general, and what exactly, did Sellers write about the word "yardstick" as stated by a Dr. James Nelson, and then about the phrase "a common language"? With your answer to the Question/Activity no. 9 above in mind, apply that word and that phrase to two other things; one each in another area of a medical- or health-related science, such as pediatrics. Explain how your choices fit this word and this phrase. (For help, see Web sites such as the ones for the journal Pediatrics, the Archives of The Future of Children—The Journal, and the Archives for Pediatric and Adolescent Medicine. [Their urls are in the Related Internet Sites section below.])
10. See Question/Activity no. 3 in this book's chapter on the Web site with Excerpts from a Letter on the Education of Women Physicians, 1851, by Dr. Elizabeth Blackwell.
11. Read "Apgar: A Commentary" (found as cited in the Related Internet Sites section below.) Why, does Dr. Fox say, the Apgar Score should never be abandoned or revised? Do you agree or disagree? Why or why not? Explain how Apgar's Score is vital today; then how and why it might be expanded to include problems that may arise in today's newborns and are unique to today's generation of infants.
12. Compare or contrast some of Dr. Fox's claims as stated in his article that is referred to in Question/Activity no. 12 above, with some claims by Dr. Selma Harrison Calmes as stated in her articles "Development of the Apgar Score" and "Virginia Apgar and the Apgar Score." (See their urls in the Related Internet Sites section below.)
13. In Dr. Calmes articles (found online as stated in Question/Activity no. 13 above), note the notes on Dr. Apgar's 1958 and 1966 papers that are research follow-ups to the research and Score of her 1953 paper. Identify how the later research is connected to the earlier research, and how the early and later research are important to each other.
14. Study Dr. Apgar's writing style, as cited at Neonatology on the Web, then study a recently published health- or medical-related article that you find at any Web site cited in this book (e.g., in the journal Pediatrics, the Archives of The Future of Children—The Journal, and the Archives of Pediatrics and Adolescent Medicine). Compare Dr. Apgar's style with the style of a medical writer of today. (Find urls for some Web sites referred to just above in the Related Internet Sites section below.)

RELATED INTERNET SITE(S)

Official Dr. Virginia Apgar Web Page

http://www.apgarfamily.com/virginia.htm

This site features biographical data on Dr. Apgar, information on the acronym suggested by Dr. Joseph Butterfield and based on her name to help one remember the features of the Apgar Score. A link leads to a speech by Eric Apgar (her grand nephew and the site's creator) accepting her induction into National Women's Hall of Fame. Other links lead to sites in the medical areas in which Dr. Apgar worked. (This page is a featured link at the Apgar Family Web site http://www.apgarfamily.com.)

"The First Test! Through the Eyes of Dr. Virginia Apgar"

http://apgar.net/virginia/SELLER_PAPER.html

This award-winning essay was written in 1998 by Sarah Sellers, a middle school student.

"Apgar: A Commentary"

http://cpmcnet.columbia.edu/news/review/archives/medrev_v1n2_0006.html

This article is an affirmation of the Apgar Score. It focuses on what the Score is, and is not, tells why it should not be revised or abandoned, and reveals why it is universally accepted and applied. Written by Dr. Harold E. Fox, of the Department of Obstetrics and Gynecology, Columbia University, College of Physicians and Surgeons, New York, the article was published in the Physicians and Surgeons Medical Review (also called the P and S Medical Review), March 1994.

"Development of the Apgar Score" and "Virginia Apgar and the Apgar Score"

http://apgar.net/virginia/Selma2.html and http://apgar.net/virginia/Selma4.html

These articles, by Dr. Selma Harrison Calmes, were published, respectively, in a 1985 publication published by Springer-Verlag, in Berlin; and in the American Society of Anesthesiologists (ASA) Newsletter, September 1997. The articles provide information on what led Apgar to develop the Score, how she went about it, and what resulted during the time shortly, and a few years after, its publication. There is data from later papers Apgar published in 1958 and 1966 as follow-ups on the research that led to the 1953 paper, and there are interviews with her colleagues.

Neonatology on the Web

http://www.neonatology.org (scroll to, and click, index link)

Links to note go to articles under Apgar, and the Apgar Scores. These articles include "Evaluation of Newborn—Apgar—Title Page" (a reproduction, with a note on Apgar's writing style and how it is different from today's medical writing style); "D.R. (Delivery Room) Exam" and "Apgar Scores (1995–1998)" which show what is being tested, the Score number, what is observed and done to determine the Score, and what condition each Score represents. There are also links to Classic Papers [in Neonatology], Literature Citation [of the Month] (with a brief description), and Resources, plus Resources Elsewhere [on the Web] that lead to writings by pediatric professionals and some articles that first appeared in medical journals, and other publications.

Newborn Screening Fact Sheets, and Table of Newborn Screening by State

http://www.aap.org/policy/01565.html

These Fact Sheets, published in the journal Pediatrics (September 1996), by the American Academy of Pediatrics, describes eleven tests now given to newborn infants in the United States, and provides a link to a table showing which states give particular tests, since no national standard requirements exist.

Newborn Screening Tests—Public Health Information Sheet

http://www.noah-health.org/pregnancy/march_of_dimes/testing/newborn.html

New York Online Access to Health (NOAH) provides this sheet as part of its mission to make available reliable consumer health information on the Web. In this sheet the March of Dimes, for the American Association of Pediatrics, describes disorders that tests detect, which tests are usually given, how soon after birth tests are done, how tests are done, and what parents should do if their babies are diagnosed with a condition.

Newborn Screening Practitioner's Manual (2002)

http://www.mostgene.edu/pract/praclist.htm (click link)

This manual, developed by members of the Newborn Screening Committee of the MoSt GeNe, and published by the Mountain States Regional Genetic Services Network emphasizes, in PDF format, guidelines in the U.S. Mountain States Region, but follows general national procedures. It describes the tests given, indicates inheritance issues, and "assists practitioners in understanding the components of newborn screening and their importance in ensuring that children affected with these conditions are able to achieve their highest potential." Before clicking the link to the manual, scroll to the bottom of the page for a link to the Network's Genetic Drift periodical online, and note especially its links to articles in the Genetic Drift Winter 1998 issue on "Issues In Newborn Screening."

Archives of Pediatrics and Adolescent Medicine

http://archpedi.ama-assn.org

See articles on medical conditions that occur in babies just days after their birth, and medical situations in pre-school-age children, plus childhood occurrences that lead to particular behavior in adolescents.

Archives of The Future of Children—The Journal

http://www.futureofchildren.org/homepage2824/archive.htm

Aiming to provide timely objective information based on the best available research, this site offers links to journal articles which feature subjects such as low birth weight, drug-exposed infants, and critical health issues for children and youth (e.g., post-9/11 stress). See also the links to the latest journal (in PDF format) with an annotated contents page, future highlights in upcoming issues, recent research, conversations with questions and answers (e.g., on early childhood development), and the Media/Press Room.

Pediatrics

http://www.pediatrics.org

At this Web site for this journal which features data on medical conditions in infants, in children during early and later childhood, and during adolescent and young adult years, see the link to the current issue's contents page, with full access to electronic articles, but access to the print issue's articles by subscription only. See also the link for browsing previous issues' contents pages and accessing those issues' electronic articles. Note the link to the contents page for the journal's upcoming issue. Article subjects range from the technical reports to scientific viewpoints of commonly-known conditions. Subjects of articles have included medical conditions related to birth rate, risk factors for the early onset of illnesses, children's injuries from community sports, cholesterol and children, and more.