How Numbers Save Babies – Celebrating the Birth of Virginia Apgar

June 6, 2014

Source: Library of Congress, Prints & Photographs Division, NYWT&S Collection, LC-USZ62-131540

I have a neonatal hero. She wasn’t a neonatologist, but every neonatologist knows her name. March of Dimes cites her as pivotal in helping them reshape their mission. She was born 105 years ago, on June 7, 1909, and she used numbers to save lives.  Her name was Virginia Apgar.

At a time where evaluation of newborns was fairly subjective – or open to gut interpretation by a doctor – Apgar, an anesthesiologist, developed a “simple, clear classification… of newborn infants” (Apgar, 1953).  She made the evaluation of newborn babies more objective. This helped her research, and it had a fantastic side-effect.

The previously used, rather subjective rankings, allowed doctors to make a call based on their gut response to the viability of the baby at birth. If the child looked sickly, if the cry was weak, the doctor might give full attention to the mother, knowing that the child was likely not to live no matter what attention they gave him or her.

Virginia Apgar’s test is simple and quick. Practitioners look at the heart rate, respiratory effort, reflex irritability, muscle tone and color of the newborn. Then they score the baby between zero (absent) to two (present) on each of those five levels a minute and then again five minutes after the baby is born. That gives an apgar score. Ten is a nearly unobtainable perfect, and a one to a three means that the child is in critical condition. Both results are charted in the child’s records.  The Apgar score was named after Virgina Apgar, but is now also used for the acronym “Appearance, Pulse, Grimace, Activity, & Respiration” to remind medical professionals of the five criteria tested.

That was it.

And it saved lives. It allowed doctors to have an objective way to measure infant outcomes based on various treatments during pregnancy and child birth. This was her intention. (Apgar, 1953) But her scoring system did more. It asked doctors not to get just a rough sense of how a baby was doing, but to look head-to-toe at the facts. Not only that, but there was a motivation to see an increase in the apgar between minute one and minute five.

Dr. Apgar noted in a journal article that “it has been most gratifying to note the enthusiastic interest and competitive spirit displayed by the obstetric house staff who took great pride in a baby with a high score” (Apgar, 1953). With a simple objective rating, eyes began to turn to the sickly child, and stabilizing the infant became a higher priority.

My son was born with an apgar score of two. His heart gained him both the points, as it was beating at greater than 100 beats per minute. Nothing else looked good. I turned my husband to my son, away from me, and begged him to take pictures while he still lived. To me the baby was most important. At minute five, his score was a six. Still not stellar, still not healthy. They whisked him to the NICU and continued to save his life for the next three months.  They did not declare him dead at birth, they focused instead on the parts of him that were working – and they helped the rest of him to come through.

Since his birth, a quick glance shows my son to be a sickly child. His list of diagnoses is long. But then if you spend time with him, analyze each and see the trajectory, you see that he is doing remarkably well. At almost two we are starting to see the beginning of the end for therapy and medical intervention.

And we are so grateful – grateful for medical professionals who do not quickly glance, but instead look to see the path our son is making. These are the ones who help him get to the next five minutes and beyond. They see progression in steps, and they delight in the steps our son is taking. They follow after Apgar’s heart.