The following is an excerpt from The Big Moo, written by one of The Group of 33.  It is one of 5 excerpts from The Big Moo published by Know More Media during this week.

This is Your First Test

You probably don’t remember the first test you took. You didn’t study and there wasn’t a private prep class for it.

You  were  one  minute  old.  No  number-two  pencils,  no  fancy equipment. Just five simple observations recorded by a doctor. It’s possible this test even saved your life.

This test is now commonly known as the Apgar score, an easy and objective method for evaluating a newborn’s health just moments after birth. It is simple, noninvasive and has saved innumerable infants’ lives around the world.

Virginia Apgar was a medical maverick. She was one of the first women ever to graduate with an M.D. from Columbia University, in 1933. In 1939 she became the first woman to head a department at Columbia University’s College of Physicians and Surgeons, and in 1949 she became the first woman to be granted a full professorship in anesthesiology at the university.

As a result of the post–World War II baby boom and a social shift away from home births, significantly more babies were now being delivered in hospitals. Originally, a baby would be born, quickly cleaned, swaddled, and sent off to the nursery. It was as- sumed  that  an  infant  was  in  good  health  unless  obvious  symptoms  of  illness  were  visible.  As  a  result,  many  respiratory  or circulatory  problems  were  not  detected.  Many  infant  deaths could have been prevented had there been a method for diagnosing a newborn’s health.

After years of evaluating newborns soon after their births during her research as a perinatal anesthesiologist, Dr. Apgar wrote, “Birth is the most hazardous time of life.” In response, she created a simple yet accurate assessment tool for evaluating a baby’s health during the crucial minutes after birth, when diagnosis and intervention could help save its life. This “Newborn Scoring Sys- tem” is now the international standard for evaluating a baby at birth.

The Newborn Scoring System assigns a maximum score of 2 points each to five criteria: heart rate, respiratory rate, reflex irri- tability  (response  to  physical  stimulation),  muscle  tone,  and color. Assessment of each of these criteria is made twice, at one and five minutes after birth. A score of at least 7 on both assess- ments indicates a high likelihood of a healthy baby. Lower scores indicate  problems  that  need  to  be  diagnosed  and,  if  necessary, treated  immediately.  To  further  simplify  this  evaluation,  the acronym “APGAR” was developed by another physician to make the five criteria easier to learn and remember. The Apgar score, as the test is now commonly referred to, stands for (A) appearance; (P) Pulse; (G) grimace; (A) activity; (R) respiratory.

As  a  colleague  of  Apgar’s  observed,  “Every  baby  born  in  a modern  hospital  anywhere  in  the  world  is  now  looked  at  first through the eyes of Virginia Apgar.” The Apgar score has made a worldwide impact on saving babies’ lives. It costs nothing, is simple to teach, and requires no complex technology. It took a lot of experience  and  common  sense  to  create  something  so  simple and streamlined. Yet the Apgar score has changed the world of perinatal care. No marketing budget, no technology, no charge. Just profound worldwide impact.

Sometimes you find remarkable innovations in the places you least expect.

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