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October 1962

Further Observations on the Newborn Scoring System

Author Affiliations

Addresses: V. Apgar, M.D., M.P.H., Director, Division of Congenital Malformations, The National Foundation, 800 2d Ave., New York 17, N.Y.; L. S. James, M.D., Presbyterian Hospital, 622 W. 168th St., New York 32, N.Y.; Recipient of Investigatorship of the Health Research Council of the City of New York under Contract 1-148 (Dr. James).; From the Departments of Anesthesiology, Obstetrics and Gynecology, and Pediatrics of the College of Physicians and Surgeons, Columbia University and from the Divisions of Anesthesiology, Obstetrics and Gynecology (Sloane Hospital), and Pediatrics (Babies Hospital) of the Presbyterian Hospital in New York.

Am J Dis Child. 1962;104(4):419-428. doi:10.1001/archpedi.1962.02080030421015

The need for a simple method whereby the newborn's condition could be rapidly evaluated was the main reason for developing a scoring system. Breathing and crying times were not satisfactory criteria, many quite severely depressed infants being treated with nothing but watchful waiting, while others who were comparatively healthy received unnecessary oxygen and manipulation.

After a 3-year period of preparatory observations at the Sloane Hospital for Women, the scoring system was first introduced in 1952.1 it is based on 5 objective signs: heart rate, respiratory effort, muscle tone, reflex irritability, and color, judged 60 seconds after delivery. This particular time interval was chosen since, on the average, it coincided with maximal depression in our clinic.

The present paper summarizes our experience of 8 years between 1952 and 1960 and considers some other applications of the system.

Predictive Value for Survival of Premature and Full-Term Infants.—It was noted previously

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