The Apgar paradox
Most of today’s readers of this journal will have received an Apgar score 1 and 5 min after birth. The measure was introduced by Virginia Apgar, an anesthesiologist, in 1952; and, since the 1960s, it is popular world-wide. The Apgar score is now ubiquitously used in newborns and arguably the most common composite screening instrument in medicine and only a few single measure screening procedures such as growth curves, glucose levels or blood pressure are more frequently employed.
In the Apgar score, neonates are assigned a numerical score of 0–2 for heart rate, respiratory rate, skin color, muscle tone, and response to stimuli resulting in a score of 0–10. The score is measured at specific periods after birth, generally 1, 5 and 10 min. The score at 1 min reflects successful transition from the womb; that at 5 min the successful adaptation to extra-uterine life, with or without medical intervention. Generally, a score of < 7 at 5 min is considered to present a risk of poor birth...