Study says Apgar score of babies is useful

Don’t throw the Apgar score out with the bath water, concluded a study out last week. Some doctors have recently questioned the value of the half-century-old Apgar system, developed to predict newborn survival in an era when dads were banned from delivery rooms and moms usually spent a week recovering in the hospital after giving birth.

The Apgar system assesses five characteristics, usually 1 minute and 5 minutes after birth: heart rate, respiration, muscle tone, reflexes and color. Each item receives a score of 0 to 2, with 10 being the top, albeit rare, score.

"With all the advances we’ve had in the last 50 years, it’s hard for people to believe that something so simple is still so good," says lead author Brian Casey of the University of Texas Southwestern Medical Center at Dallas.

One problem, Casey says, is that some doctors think the Apgar system should be able to identify whether babies have been deprived of oxygen or predict their neurological development, tasks it was never designed to do.

Although obstetrical anesthesiologist Virginia Apgar developed the system back in 1952, it remains just as useful today, Casey and his colleagues write in the New England Journal of Medicine.

The researchers base their conclusion on an analysis of 145,627 infants, nearly all the babies born alive from 1988 through 1998 at Parkland Hospital in Dallas.

Besides getting Apgar scores at 1 and 5 minutes after birth, the babies had the pH, or acidity, level of their umbilical cord blood measured. Some doctors have proposed that the pH test is better at predicting the chance of surviving the first four weeks of life.

Casey and his collaborators found the reverse to be true. Among full-term babies, a 5-minute Apgar score of 3 or less was eight times more likely to identify babies who would soon die than highly acidic cord blood was.

"Until a more useful tool for assessing (newborns) is developed, the 5-minute Apgar score á is still valid as a rapid method for assessing the vitality of the infant," Lu-Ann Papile, a University of New Mexico pediatrician, writes in an accompanying editorial.

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