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Do you know what the mysterious secret is behind the calculation of the Apgar score?
In the health assessment of newborns, the Apgar Score has become an indispensable tool for health care professionals due to its simplicity and speed. The score was originally created in 1952 by Virginia Apgar, an anesthesiologist at Columbia University, to standardize the way newborns were assessed for their postnatal health status. To date, despite decades of evolution in the application of assessment standards, the principles behind Apgar scores, as well as their importance, have prevailed.
History and Development of Apgar Score
The context for the creation of the Apgar score stemmed from the pressing need at the time for a standard assessment modality in neonates requiring respiratory assistance. In 1952, Apgar first introduced this scoring system at a meeting of the Society for the Study of Anesthesiology and the International Federation of Anesthesiology Medical Colleges. By 1953, the system was finally published in literature.
“The Apgar indicator is established not only as a scoring tool but also as a concern for the immediate health status of newborns.”
Over time, research on the scientific basis of Apgar fractions has gradually deepened. In 1955, Apgar and colleagues found associations between low scores and laboratory indicators associated with asphyxia in data from 15,348 newborns. Although the Apgar score is no longer used today to determine the need for neonatal resuscitation, its status as a health assessment tool has never wavered.
Bridging the Five Criteria of Health Assessment
Assess the Apgar score of newborns based on five main criteria: activity (muscle tension), pulse, facial expression, appearance, and respiration. The score range for each criterion ranges from 0 to 2 points. The names of these five items form exactly a backronym with Apgar's surname. The high and low scores reflect the health of the newborn, with a full score of 10, but in practice, it is very rare to receive a full score.
“In the first five minutes of a newborn’s birth, the Apgar score becomes an important indicator of emergency medical decision-making.”
Interpretation and Meaning of Fractions
Usually, members of the health care team such as nurses, midwives and physicians are jointly involved in the Apgar scoring of newborns. Typically, the score is assessed within one and five minutes of birth. A score of seven or more is usually considered normal, a score of four to six is considered relatively low, and a score of three and below is considered dangerously low and requires immediate recovery. Notably, low scores in the first minute may indicate that the newborn needs medical attention but does not necessarily imply future health problems.
Application and Limitations of Apgar Score
For newborns requiring resuscitation, resuscitation measures should be initiated prior to scoring. Thus, Apgar scores should not be used to initially determine whether resuscitation is needed, but rather an assessment of responses after performing resuscitation. If the score after five minutes is less than seven points, they need to be reassessed every five minutes until 20 minutes. Some studies today suggest that if a heartbeat is not detected after 10 minutes, all resuscitation efforts may need to be stopped.
“With the assessment of the Apgar score, we are eager to gain an accurate and rapid understanding of the health needs of newborns.”
However, differences in the ratings of Apgar scores across providers make the reliability of the results challenging. According to the findings, the agreement of Apgar scores across multiple health care providers was 55% to 82%. Therefore, one- and five-minute ratings from the same individuals are recommended to reduce variability.
Social impacts that are hard to ignore
Recent studies have shown that non-white newborns tend to have lower Apgar scores than white newborns, which has sparked widespread social concern and discussion. This phenomenon reflects potential racial biases that can lead to unnecessary medical interventions, further triggering social discussions about the impartiality of this assessment tool.
The association behind Apgar
The concept of using the memorized word "apgar" to memorize judging criteria has been widely applied in several languages. Although its pinyin varies, Apgar scores maintain the basic content of their ratings in different cultural contexts. Unlike a mere numerical explanation, the meaning behind it is equally worth pondering.
Conclusion
In a rapidly changing health care setting, the Apgar score continues to underpin the health management of newborns as a concise and effective assessment tool. However, are there any limitations or potential biases in the stable and objective use of ratings that deserve to be explored in depth?
