the standard of practice all over the world, as well as
an early marker for later developmental outcomes.
In 1959 Apgar left Columbia University to attend
John Hopkins University in pursuit of her master’s
degree in public health; she also studied statistics to
improve her research skills. In April of 1959 Apgar
was appointed by the director of the National Foun-
dation-March of Dimes (now the Dimes Birth Defects
Foundation) to assist in its effort to promote public
awareness of birth defects. From 1967 to 1972 Apgar
served as Director of Basic Research of the National
Foundation. She later co-authored the book Is My
Baby All Right? (1972), which dealt with birth defects,
with Joan Beck. Apgar died August 7, 1974.
See also: APGAR SCORING SYSTEM; INFANCY
Bibliography
‘‘Apgar, Virginia.’’ In the Discovery Channel School [web site].
Available from http://school.discovery.com/homeworkhelp/
worldbook/atozscience/a/726460.html; INTERNET.
‘‘Apgar, Virginia.’’ In the Encyclopædia Britannica [web site]. 1999.
Available from http://women.eb.com/women/articles/
Apgar_Virginia.html; INTERNET.
Calmes, Selma Harrison. ‘‘Virginia Apgar: A Woman Physician’s
Career in a Developing Specialty.’’ Journal of the American Med-
ical Women’s Association 39, no. 6 (1984):184–188. Available
from http://www.apgarfamily.com/Selma1.html; INTERNET.
Publications by Apgar
‘‘A Proposal for a New Method of Evaluation of the Newborn
Infant.’’ Available from http://www.apgarfamily.com/
drvirginial1.htm; INTERNET.
Rosemary C. White-Traut
APGAR SCORING SYSTEM
The APGAR scoring system is used universally in the
delivery room to assess the overall health and integri-
ty of the newborn immediately after birth. A score of
zero to two is assigned in each of the five areas at one
and five minutes after birth. If prolonged resuscita-
tion is needed, scoring continues at five minute inter-
vals until the infant is stabilized. The five areas are:
Activity—from no movement (0) to tone, movement,
and flexion (2); Pulse—from absent (0) to more than
one hundred beats per minute (2); Grimace—from
no reflex irritability (0) to cough or pulling away (2);
Appearance—from blue-gray color (0) to normal (2);
and Respiration—from absent (0) to regular with cry-
ing (2). A score of seven to ten is normal. A score of
four to seven signals a need for resuscitation. And a
score of three or below signals the need for intense,
and sometimes prolonged, resuscitation. A low score
(less than three) of long duration (greater than ten
minutes) may correlate with future neurological dys-
function.
See also: APGAR, VIRGINIA; BIRTH; INFANCY
Bibliography
Committee on Fetus and Newborn, American Academy of Pediat-
rics, and Committee on Obstetric Practice, American College
of Obstetricians and Gynecologists. Policy Statement. ‘‘Use
and Abuse of the APGAR Score.’’ Pediatrics 98, no. 1
(1996):141–142.
Freeman, John, and Karin Nelson. ‘‘Intrapartum Asphyxia and Ce-
rebral Palsy.’’ Pediatrics 82, no. 2 (1988):240–249.
Goodwin, T. Murphy. ‘‘Role of the APGAR Score in Assessing Per-
inatal Asphyxia.’’ Contemporary OB/GYN (June 1997):80–92.
Nelson, Karin, and Jonas Ellenberg. ‘‘Obstetric Complications as
Risk Factors for Cerebral or Seizure Disorders.’’ Journal of the
American Medical Association (1984):251, 1843–1848.
Socol, Michael, Patricia Garcia, and Susan Riter. ‘‘Depressed
APGAR Scores, Acid-Base Status, and Neurologic Outcome.’’
American Journal of Obstetrics and Gynecology 170, no. 4
(1994):991–999.
Joanne BregmanAPNEA
Apnea is a condition when breathing stops during
sleep. Since common brain processes regulate both
sleep and breath, respiration is controlled differently
when we are awake and asleep. Breathing may stop
because the brain fails to tell the muscles in the lungs
to contract or expand (central apnea) or because of
physical obstruction of the upper airway, with breath-
ing muscles in the diaphragm and chest continuing
to function (obstructive apnea), or both combined
(mixed apnea). Apneic pauses as brief as two to six
seconds normally occur in infants and children. If
they last longer (say, fifteen to twenty seconds), occur
frequently, and are accompanied by lowered blood
oxygen levels (hypoxemia), the developing brain is
deprived of needed oxygen. If untreated, this Ob-
structive Sleep Apnea Syndrome (OSAS) places a
child at risk for mental deficits, heart and respiratory
abnormalities, and even death. This respiratory dys-
function has been associated with snoring, as well as
upper respiratory infection, Down syndrome, Prader-
Willi syndrome, Attention Deficit Hyperactivity Dis-
order (ADHD), epilepsy, and sudden infant death
syndrome (SIDS). Protection against its effects can be
provided by treatment with continuous positive air-
way pressure (CPAP) during sleeping as well as a
number of drugs.See also: SLEEPINGBibliography
Carroll, John, and Gerald Loughlin. ‘‘Obstructive Sleep Apnea
Syndrome in Infants and Children: Diagnosis and Manage-
ment.’’ In Richard Ferber and Meier Kryger eds., Principles
and Practice of Sleep Medicine in the Child. Philadelphia: W. B.
Saunders, 1995.
Evelyn B. Thoman26 APGAR SCORING SYSTEM