UNIVERSITY OF COLORADO
     MEDICAL CENTER

    4200 EAST NINTH AVENUE

DENVER 20. COLORADO

DEPARTMENT OF PEDIATRICS

PREMATURE INFANT CENTER

27 July 1961

COLORADO GENERAL HOSPITAL

C 0 LO RAD0

PSY C H 0 PATH IC

H 0 SPITAL

SCHOOL OF MEDICINE

Virginia Apgar, M.D.
800 Second Avenue
New York 17, New York

Dear Doctor Apgar:

Enclosed is an epigram of your scoring system which has been quite helpful in
instructing medical students, interns and nursing personnel. This was suggested
to me by one of our former residents and I send it on to you in the form that I
have used in a teaching slide.

We are presently writing up a clinical evaluation of the effect of early feeding
of 20 per cent glucose to premature infants with the respiratory distress
syndrome. There were 34 infants, weighing 1030 - 1700 grams, in the group;
20 of whom developed the respiratory distress syndrome. In this small series,
we were unable to see a correlation of the Apgar score with either the respira-
tory distress syndrome or mortality. Although your reports of larger numbers of
premature infants have shown a positive correlation, I wonder whether the smaller
prematures also revealed that association - since in the 14 infants reported in
Auld's recent paper (Am J Dis Child, 101:713, 1961), there was scattered mortality
and in Phillips 1959 report in the Canad MAJ, 61 infants, less than 1750 grams,
had as many deaths in the eight plus group (10 of 33) as in the seven minus
group (9 of 28).

Although I would appreciate your comments on the latter points, I primarily wanted
to send you this epigram (at Doctor Lubchenco's encouragement) and tell you that
we have found the scoring system an effective means of evaluating the larger in-
fants at birth.

Sincerely,

LyJoseph Butterf ielx M.D.
Senior Instructor
Department of Pediatrics

LJB: jt
Enc 1 osur e

INFANT

A= APPEARANCE

Pr PULSE

G= GRIMACE

A= ACTIVITY

R c. RESPIRATION

EVALUATION AT BIRTH

BODY PINK

BLUE E X TI B L U E PINK

ABSENT BELOW I00 OVER 100

COUGH

ABSE NT GRIMACE SNEEZE

LIMP FLEXION ACTIVE

SLOW GOOD

ABSENT IR R E GULAR CRYINB

(with apology to VIRGINIA APGAR,MD)