For nearly 60 years, every baby born in the United States and worldwide has been seen through the eyes of Virginia Apgar, MD, who developed the five-point APGAR score to evaluate an infant’s health at birth.
Today marks the 100th anniversary of Dr. Apgar’s own birth, and the March of Dimes, the organization she worked for from 1959 until her death in 1974, is calling attention to her enduring legacy in infant health. Most famous is the APGAR score, which she created in 1952 as a new way to determine if a baby needed specialized care. It measures an infant’s pulse, skin color, reflex, muscle tone, and respiration and still today is given at one and five minutes after birth.
The APGAR scoring system helped reduce infant mortality and spurred the creation of neonatal health as a medical focus, establishing the need for facilities, protocols and professionals to provide specialized care, said Alan R. Fleischman, MD, March of Dimes medical director.
“Every baby born in America benefits from Dr. Apgar's pioneering work to identify quickly which newborns need emergency care or have a serious birth defect,” said Dr. Fleischman. “The babies whose lives are saved by the special care in newborn intensive care units particularly benefit from her efforts to develop the resources that made these units possible.”
Today, the March of Dimes NICU Family Support® project provides information and comfort to families with a sick or premature baby in the NICU, during the transition to home, and in the event of a newborn death. It also contributes to NICU staff professional development and seeks to promote a family-centered philosophy in NICUs throughout the country.
Dr. Apgar was an advocate for universal rubella (German measles) vaccination to prevent women from passing along the disease to their unborn children. Although rubella is usually a mild childhood disease, it can cause serious birth defects if a woman becomes infected while pregnant. Dr. Apgar’s efforts followed a 1964 rubella epidemic that caused about 50,000 abnormal pregnancies, including 20,000 babies born with birth defects and 30,000 fetal deaths. Dr. Apgar also promoted effective use of Rh tests, which can prevent a woman’s antibodies from crossing the placenta and attacking the fetus’ red blood cells, perhaps causing miscarriage or fetal death.
Dr. Apgar, a pediatric anestheologist, was also a noted teacher, author and mentor to other physicians. She served as vice president for Medical Affairs at the March of Dimes and directed the Foundation's research program to prevent and treat birth defects. While Dr. Apgar’s message had a profound effect on the lives of individuals, her focus often was on big-picture programs and policies, Dr. Fleischman says.
Dr. Apgar influenced the creation of the first Committee on Perinatal Health, which published “Toward Improving the Outcome of Pregnancy,” a plan to regionalize perinatal care and ensure the best use of hospital resources as neonatal care and newborn intensive care units were being developed. In the ensuing years, a second report recommended providing high-quality care from preconception through birth and after delivery. In 2010, the March of Dimes will work with physician and nursing organizations on a third report that will focus on opportunities to improve perinatal health, including quality improvement, patient safety and performance improvement.
Because gestational age is directly related to an infant’s APGAR score, Dr. Apgar was one of the first at the March of Dimes to bring attention to the problem of premature birth, now one of the March of Dimes top priorities.
Dr. Apgar was equally at home speaking to teens as she was to the movers and shakers of society. She spoke at March of Dimes Youth Conferences about teen pregnancy and birth defects at a time when these topics were considered taboo. She campaigned vigorously for birth defects registries and for making genetic history and pregnancy history a routine part of medical recordkeeping for pregnant women, which it now is today. She was the author, with Joan Beck, of "Is My Baby All Right? A Guide to Birth Defects," published in 1972.