Apgar Scale

Invented by : Dr. Virginia Apgar

Invented in year : 1952

Apgar Scale is a simple, quick and effective method used to measure the health of a newborn child and to determine if the infant needs any emergency treatment. The procedure was developed in 1952 by an anaesthesiologist named Virginia Apgar. According to the procedure, an infant is evaluated for the following, at one minute and again at five minutes after birth.

Heart rate.
Respiration.
Muscle tone.
Reflex response.
Colour (Doctors check the soles of the feet and the palms of the hands in dark-skinned children.)

Each factor is given a score between zero and two and the scores are then totalled. Most newborns score between seven and ten and do not need immediate treatment, such as help in breathing. A practitioner checks each of the following factors - she can usually tell what's going on just by looking at your baby - she assigns it a score between zero and two. Afterwards, the scores are totalled. (Note that some of these factors, including your baby's heart rate, breathing, and colour are first assessed immediately after birth so that resuscitation can begin right away if there is any problem.)

                                  0                   1                                2
Heart rate                Absent.       < 100 per minute.         100-140 per minute.
Respiration              Absent.        Irregular.                      Strong, crying.
Reflex Irritability      Absent.        Weak.                           Grimace, sneeze.
Muscle tone             Flaccid.        Some flexion .                Strong flexion.
Color                       Blue.            Extremities blue.            Pink.

An assessment of the physical condition of a newborn infant; involves heart rate and muscle tone and respiratory effort and colour and reflex responsiveness. A system of evaluating a newborn's physical condition by assigning a value (0, 1, or 2) to each of five criteria: heart rate, respiratory effort, muscle tone, response to stimuli, and skin colour. The score that a baby acquires in this test is known as  Apgar Scale.

History of the Invention

Virginia Apgar (7 June 1909–7 August 1974) was an American physician  who specialised in anaesthesia. She was a leader in the fields of anaesthesiology and teratology, and effectively founded the field of neonatology. In 1949, when anaesthesia research became an academic department, Dr. Apgar was appointed the first woman full professor at the Columbia University College of Physicians and Surgeons. She began studying obstetrical anaesthesia — the effects of anaesthesia given to a mother during labour on her newborn baby. During that time, the infant mortality In America was still considerably higher than in many European countries. Though Infant mortality figures overall improved between 1930 and 1950, but the mortality rates for the first 24 hours after birth changed hardly at all. Relieved of the demands of administration, Apgar focused her teaching and research on this problem. She observed that in many cases, newborns could be saved if anyone bothered to examine them closely just after birth. Oxygen lack (anoxia) played a major role in at least half of newborn deaths. Besides this, Apgar noted, resuscitation of infants at birth was a topic fraught with strong opinions, imaginative ideas, and unscientific studies. There was little agreement about what was "normal" just after birth, and when intervention was needed.

It was while researching about the solution to this problem that she made her greatest contribution to the field, the Apgar Score. This was the first standardized method for evaluating the newborn's transition to life outside the womb. "Five points—heart rate, respiratory effort, muscle tone, reflex response, and colour — are observed and given 0, 1, or 2 points. The points are then totalled to arrive at the baby's score." 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.

Development in the Invention of Apgar Scale

Apgar went on to relate the score more closely to the effects of labour, delivery, and maternal aesthetics 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 anaesthesia, and contributing specialized 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 anaesthesia to the mother was likely to result in an infant's low Apgar Score. Finally, the Collaborative Project, a twelve-institution study involving 17,221 babies, established that the Apgar Score, especially the five-minute score, can predict neonatal survival and neurological development.

Some ten years after the initial publication, the acronym APGAR was coined in the US as a mnemonic learning aid:

Appearance - Skin Colour.
Pulse - Heart Rate.
Grimace - Reflex Irritability.
Activity - Muscle Tone.
Respiration.

Role of Apgar Scale in the development of Human Life.

• The Scale enabled a correct prediction of neonatal survival and neurological development.
• It helped further research and studies in the field of Neonatology.
• The method reduced infant mortality and became a standard obstetric practice for about forty years.