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The Virginia Apgar Papers

Title:
Accurate Apgar Scoring: A Proposal for a New Method of Evaluation of the Newborn Infant pdf (157,199 Bytes) transcript of pdf
Accurate Apgar Scoring: A Proposal for a New Method of Evaluation of the Newborn Infant
Description:
This pamphlet accompanied an exhibit at the Twenty-Second Postgraduate Assembly in Anesthesiology, December 16-18, 1968. It was supplied by Resuscitation Labs, a company which produced score pads and clipboards (with attached timer) for recording Apgar scores, and is an example of the Apgar score's widespread acceptance by the late 1960s.
Number of Image Pages:
4 (157,199 Bytes)
Date Supplied:
December 1968
Creator:
Resuscitation Labs
Source:
Original Repository: Mount Holyoke College. Archives and Special Collections. Virginia Apgar Papers [MS 0504]
Rights:
Courtesy of Mount Holyoke College.
The National Library of Medicine's Profiles in Science program has made every effort to secure proper permissions for posting items on the web site. In this instance, however, it has either not been possible to identify or contact the current copyright owner. If you have information regarding the copyright owner, please contact us at profiles@nlm.nih.gov.
Subject:
Medical Subject Headings (MeSH):
Apgar Score
Infant, Newborn
Exhibit Category:
Second Career: The National Foundation-March of Dimes, 1959-1974
Box Number: 13
Folder Number: 3
Unique Identifier:
CPBBGV
Document Type:
Pamphlets
Language:
English
Format:
application/pdf
image/tif
Physical Condition:
Good
Series: Apgar Score Material 1959-1973
Folder: Articles 1966-1969
Transcript:
ACCURATE APGAR SCORING
A proposal for a new method of evaluation of the newborn infant.
A scientific exhibit presented at the Twenty-Second Postgraduate Assembly in Anesthesiology
New York Hilton Hotel
December 16, 17 and 18, 1968
SIGNIFICANCE OF THE APGAR SCORE
As in other pathological conditions, treatment of newborn depression rests upon accurate diagnosis. The various physical signs are conveniently summarized by the Apgar Score. This has little relation to oxygenation but does reflect the degree of acidosis. (Fig. 1) A score from 7-10 generally applies to a "vigorous", 4-6 to a "depressed" and 0-3 to a "markedly depressed" infant. (1) (2) (3).
In addition to the predictive value for survival, there is a relationship between the Score and the development of neuromuscular deficits in childhood. Fig. (2-3)
[DIAGRAM = "Fig. 1 Comparison of vigorous and depressed APGAR SCORE to acidosis. (5)"]
[DIAGRAM = "Fig. 2 Apgar Scores and outcome of newborn. (3)"]
[DIAGRAM = "Fig. 3 Percentage of neurological abnormality at 1 year, by 1 and 5 minutes score, by birth weight and by combination of birth weight and 5 minutes score. (3)"]
"Nine months observation of the mother surely warrants one minute observation of the baby" -- V. Apgar
TECHNIQUE OF "SCORING"
A) Observations are made exactly at one, five, and ten minutes after delivery of the entire infant.
B) The modalities listed are obtained according to the table below and appropriate values assigned.
Sign; 0; 1; 2
Heart rate; Absent; Slow (Below 100); Over 100
Respiratory effort; Absent; Slow, irregular; Good, crying
Muscle tone: Flaccid; Some flexion of extremities; Active motion
Reflex irritability; No response; Grimace; Cry
Color; Blue, pale; Body pink, extremities blue; Completely pink
C) In order to be consistent, and to gain the full advantage of proper treatment and prognosis, it is imperative that scores be recorded in their proper time sequence.
The "APGAR SCORE TIMING UNIT" (shown below) has made such temporal accuracy possible.
[IMAGE]
APGAR SCORE SHEET
PITFALLS AND PROBLEMS
1. Subjectivity of persons involved in delivery.
2. Making tabulation at accurate time intervals.
3. Difficulty of monitoring heart beat when working alone.
4. Respiratory effort may be difficult to assess.
5. Cyanosis may persist peripherally in many "healthy" infants.
SUGGESTED EQUIPMENT FOR INFANT CARE AND RESUSCITATION IN THE DELIVERY ROOM
1. Timer and APGAR SCORE sheet
2. Laryngoscope
3. Airways
4. Cole endotracheal tubes of various sizes
5. Suction
6. Infant warmer with thermostat
7. Oxygen -- both positive pressure and flow
8. Umbilical vessel canula
9. Sodium Bicarbonate ampoules
10. Epinephrine ampoules
REFERENCES:
1. A proposal for a new method of evaluation of the newborn infant.
V. Apgar -- Anesth. Analg. 32:260, 1953
2. The newborn (APGAR) scoring system
V. Apgar -- Pediatrics Clinics of North America -- 645, 1966
3. Apgar scores and outcome of the newborn
J. S. Drage, M.D., H. Berendes, M.D.
Pediatrics Clinics of North America -- 635, 1966
4. Resuscitation of the depressed baby.
B. Smith, M.D., F. Moya, M.D. -- Anesth; 26:552, 1965
5. Pattern of recovery of buffer base in the first hour of life.
James, S. L. Bull. Sloane Hosp. Wom. 5:107, 1959
David J. Hammer, M.D.
Raymond Portu, M.D.
Arthur Santiago, M.D.
Miguel A. Colon-Morales, M.D.
Jewish Hospital and Medical Center of Brooklyn
Teachers Hospital, Hato Rey, Puerto Rico
"Apgar Score Timer Unit" [copyright] and "Apgar Score Pad" [copyright]
Developed by the Department of Anaesthesiology
Teachers Hospital, Hato Rey, Puerto Rico
supplied by RESUSCITATION LABS
P.O. Box 3051, Bridgeport, Conn. 06605
Metadata Last Modified Date:
2009-04-06
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