‘The baby died, Doctor. I was sure something was wrong. We lost her in a day.’ Dr. Virginia, the senior anaesthetist at the Columbia Presbyterian Medical Centre closed her eyes as the nurse spoke. Her mind was in turmoil.
‘What are we missing? Why aren’t we saving these infants?’
In the early 50’s, the overall infant mortality rates were down but the number of infant deaths in the first 24 hours was a terrible constant.
A medical resident asked her the next day at breakfast ‘Doctor, how would you make a systematic assessment of a new born?’
‘You know, the problem is that different physicians and midwives use different cues. Some focus on breathing. Others check on the baby crying. Everyone is using their own judgement. That’s the problem’
She then grabbed a paper and started writing ‘But now that you ask me, I think it’s easy’. She jotted down 5 variables – heart rate, respiration, reflex, muscle tone and colour – and put 3 scores next to each of them – 0, 1 or 2, depending on the robustness of each sign. She rushed into the delivery wing and got herself and every nurse to fill up this checklist immediately after 1 minute of a baby’s birth.
Dr Virginia Apgar saw dramatic results. Babies with a total score of 8 or above were in the pink of health. Babies who scored less than 4 were probably flaccid or bluish and urgent action was taken on them.
Since 1953, the APGAR score – Appearance, Pulse, Grimace, Activity and Respiration has saved lakhs of new born lives and bought down infant mortality rate. And it continues to be the standard practice across the world till this date.
A story on how a simple checklist can still save a million infant lives!
From Daniel Kahneman’s International Bestseller, Thinking Fast and Slow, 2011
Additional Reading on Dr. Virgina Apgar from here
Detailed understanding of the APGAR score and it’s efficacy