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Apgar score

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The Apgar score is a quick way for health professionals to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation . It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar , to address the need for a standardized way to evaluate infants shortly after birth.

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63-413: Today, the categories developed by Apgar used to assess the health of a newborn remain largely the same as in 1952, though the way they are implemented and used has evolved over the years. The score is determined through the evaluation of the newborn in five criteria: activity (tone), pulse, grimace, appearance, and respiration. For each criterion, newborns can receive a score from 0 to 2. The list of criteria

126-570: A backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record. Another mnemonic for the test is "How Ready Is This Child?", which summarizes the test criteria as Heart rate, Respiratory effort, Irritability, Tone, and Color. Backronym A backronym

189-494: A public health emergency of international concern, marking the second such declaration in the last two years due to the virus's transmission. The WHO's Constitution states that its objective "is the attainment by all people of the highest possible level of health". The WHO fulfils this objective through its functions as defined in its Constitution: As of 2012 , the WHO has defined its role in public health as follows: Since

252-465: A backronym is "an acronym deliberately formed from a phrase whose initial letters spell out a particular word or words, either to create a memorable name or as a fanciful explanation of a word's origin". Many fictional espionage organizations are backronyms, such as SPECTRE (special executive for counterintelligence, terrorism, revenge and extortion) from the James Bond franchise. For example,

315-502: A convention concerning the bubonic plague was signed by sixteen of the nineteen states attending the Venice conference. While Denmark , Sweden-Norway , and the US did not sign this convention, it was unanimously agreed that the work of the prior conferences should be codified for implementation. Subsequent conferences, from 1902 until the final one in 1938, widened the diseases of concern for

378-778: A forum for scientific or policy discussions related to health. Its official publication, the World Health Report , provides assessments of worldwide health topics. The WHO has played a leading role in several public health achievements, most notably the eradication of smallpox , the eradication of polio , and the development of an Ebola vaccine . Its current priorities include communicable diseases , such as HIV/AIDS , Ebola , malaria and tuberculosis ; non-communicable diseases such as heart disease and cancer ; healthy diet , nutrition, and food security ; occupational health ; and substance abuse . The agency advocates for universal health care coverage, engagement with

441-399: A long-term problem, particularly if the score improves at the five-minute mark. A constellation of factors may contribute to a low Apgar score value. An Apgar score that remains below three at five minutes and later times, such as 10, 15, or 30 minutes, does not provide supporting evidence for a specific illness but can sometimes be among the first indicators of neonatal encephalopathy. However,

504-543: A recent retrospective study including 17 infants with an Apgar score of 0 at 10 minutes who received therapeutic hypothermia , 4 of the 8 surviving babies had no neurological abnormalities and only 1 infant had severe abnormalities, as assessed through brain MRI . During neonatal resuscitation, Apgar scores may not accurately represent the condition of the neonate as resuscitation measures (i.e. positive pressure ventilation and chest compressions) may artificially elevate scores. As

567-540: A resolution on disability prevention and rehabilitation , with a focus on community-driven care. 1977 and 1978: The first list of essential medicines was drawn up, and a year later the ambitious goal of " Health For All " was declared. 1986: The WHO began its global programme on HIV/AIDS . Two years later preventing discrimination against patients was attended to and in 1996 the Joint United Nations Programme on HIV/AIDS (UNAIDS)

630-429: A resolution passed on the subject, Alger Hiss , the secretary general of the conference, recommended using a declaration to establish such an organization. Sze and other delegates lobbied and a declaration passed calling for an international conference on health. The use of the word "world", rather than "international", emphasized the truly global nature of what the organization was seeking to achieve. The constitution of

693-572: A result, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage the use of an expanded Apgar score report, which records resuscitation efforts utilized at each time point. A systematic review that analyzed the relationship between umbilical cord pH and neonatal outcomes found that low cord pH is strongly correlated with mortality, morbidity and cerebral palsy in childhood. To reduce

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756-508: A series of conferences that took place until 1938, about 87 years. The first conference, in Paris, was almost solely concerned with cholera , which would remain the disease of major concern for the ISC for most of the 19th century. With the cause , origin, and communicability of many epidemic diseases still uncertain and a matter of scientific argument, international agreement on appropriate measures

819-643: A way to determine the need for newborn resuscitation because supportive measures must be implemented prior to 1 minute after birth, the first time-point at which the Apgar score is determined. However, the Apgar score is a method of assessment endorsed by the American College of Obstetricians and Gynecologist and the American Academy of Pediatrics . Various members of the healthcare team, including midwives, nurses, or physicians, may be involved in

882-584: Is a backronym of Apgar's surname. Apgar originally developed the criteria as a way to address the lack of a standardized way to assess the need for assistive breathing procedures for newborns. In 1952, after some refinement of her initial system, Apgar presented the Apgar score at a joint meeting between the International Anesthesia Research Society and the International College of Anesthetists, and it

945-447: Is an acronym formed from an already existing word by expanding its letters into the words of a phrase. Backronyms may be invented with either serious or humorous intent, or they may be a type of false etymology or folk etymology . The word is a portmanteau of back and acronym . A normal acronym is a word derived from the initial letters of the words of a phrase, such as radar from "radio detection and ranging". By contrast,

1008-478: Is headquartered in Geneva , Switzerland, and has six regional offices and 150 field offices worldwide. Only sovereign States can participate, and it is the largest intergovernmental health organization at the international level. The WHO's purpose is to achieve the highest possible level of health for all the world's people, defining health as "a state of complete physical, mental and social well-being and not merely

1071-557: Is now on the verge of extinction, thanks to a Global Vaccination Drive. The World Health Organization (WHO) stated the eradication programme has saved millions from deadly disease. Between 1990 and 2010, WHO's help has contributed to a 40% decline in the number of deaths from tuberculosis, and since 2005, over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardising treatment, monitoring of

1134-570: Is preferred that the same individual determine the 1-minute and 5-minute Apgar scores. A 2023 paper by Amos Grunebaum , which reviewed the care of nine million babies, was published in the Journal of Perinatal Medicine ; the report showed that non-white babies were given lower Apgar scores than white babies, as their darker skin color often results in lower scores on the appearance measure, making them more likely to receive medical care that might not be needed. Some ten years after initial publication,

1197-440: Is probably of Romani origin but commonly believed to be a backronym of "council-housed and violent". Similarly, the distress signal SOS is often believed to be an abbreviation for "save our ship" or "save our souls" but was chosen because it has a simple and unmistakable Morse code representation – three dots, three dashes, and three dots, sent without any pauses between characters. More recent examples include

1260-531: The Amber Alert missing-child program was named after Amber Hagerman , a nine-year-old girl who was abducted and murdered in 1996. Officials later publicized the backronym "America's Missing: Broadcast Emergency Response". An example of a backronym as a mnemonic is the Apgar score , used to assess the health of newborn babies. The rating system was devised by and named after Virginia Apgar . Ten years after

1323-585: The US Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and smaller organizations. As of 2011 , it has been working to immunize young children and prevent the re-emergence of cases in countries declared "polio-free". In 2017, a study was conducted as to why Polio Vaccines may not be enough to eradicate the Virus & conduct new technology. Polio

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1386-857: The USSR , called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54. 1965: The first report on diabetes mellitus and the creation of the International Agency for Research on Cancer . 1966: The WHO moved its headquarters from the Ariana wing at the Palace of Nations to a newly constructed headquarters elsewhere in Geneva. 1967: The WHO intensified

1449-1043: The United Nations Development Programme (UNDP), and the World Bank . 1975: The WHO launched the Special Programme for Research and Training in Tropical diseases (the TDR). Co-sponsored by UNICEF , UNDP, and the World Bank, it was established in response to a 1974 request from the WHA for an intensive effort to develop improved control of tropical diseases. The TDR's goals are, firstly, to support and coordinate international research into diagnosis, treatment and control of tropical diseases; and, secondly, to strengthen research capabilities within endemic countries. 1976: The WHA enacted

1512-572: The World Health Assembly finished on 24 July 1948, having secured a budget of US$ 5 million (then £1,250,000 ) for the 1949 year. G. Brock Chisholm was appointed director-general of the WHO, having served as executive secretary and a founding member during the planning stages, while Andrija Štampar was the assembly's first president. Its first priorities were to control the spread of malaria , tuberculosis and sexually transmitted infections , and to improve maternal and child health , nutrition and environmental hygiene. Its first legislative act

1575-536: The Apgar score is assigned at the one-minute mark. Therefore, the Apgar score is not used to determine if initial resuscitation is needed, rather it is used to determine if resuscitation efforts should be continued. Variation between the one-minute and five-minute Apgar scores can be used to assess an infant's response to resuscitation. If the score is below seven at the five-minute mark, the Neonatal Resuscitation Program guidelines specify that

1638-459: The Apgar scoring of a neonate. The test is generally done at one and five minutes after birth and may be repeated later if the score is and remains low. Scores of seven and above are generally normal; four to six, fairly low; and three and below are generally regarded as critically low and cause for immediate resuscitative efforts. A low score on the one-minute mark may show that the neonate requires medical attention, but does not necessarily indicate

1701-444: The Apgar test's purpose is to determine quickly whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues. A score of 10 is uncommon, due to the prevalence of transient cyanosis , and does not substantially differ from a score of nine. Transient cyanosis is common, particularly in babies born at high altitude. In cases where a newborn needs resuscitation, it should be initiated before

1764-620: The Health Organization of the League of Nations. After World War II , the United Nations absorbed all the other health organizations, to form the WHO. During the 1945 United Nations Conference on International Organization, Szeming Sze , a delegate from China, conferred with Norwegian and Brazilian delegates on creating an international health organization under the auspices of the new United Nations. After failing to get

1827-686: The ISC, and included discussions of responses to yellow fever , brucellosis , leprosy , tuberculosis , and typhoid . In part as a result of the successes of the Conferences, the Pan-American Sanitary Bureau (1902), and the Office International d'Hygiène Publique or " International office of Public Hygiene " in english(1907) were soon founded. When the League of Nations was formed in 1920, it established

1890-667: The United Nations together with the exchange of letters related thereto, and taking into account the respective co-ordinating responsibilities of both organizations, it is recognized by the World Health Organization that the International Atomic Energy Agency has the primary responsibility for encouraging, assisting and co-ordinating research and development and practical application of atomic energy for peaceful uses throughout

1953-483: The WHO over the organization's unwillingness to share the penicillin recipe. They would not return until 1956. 1950: A mass tuberculosis inoculation drive using the BCG vaccine gets under way. 1955: The malaria eradication programme was launched, although objectives were later modified. (In most areas, the programme goals became control instead of eradication.) 1958: Viktor Zhdanov , Deputy Minister of Health for

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2016-604: The WHO was to report as to whether RTS,S /AS01, were a viable malaria vaccine . For the time being, insecticide -treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children. In 1988, WHO launched the Global Polio Eradication Initiative to eradicate polio . It has also been successful in helping to reduce cases by 99% since WHO partnered with Rotary International ,

2079-425: The WHO's role and priorities in public health, ranging from narrowing its mandate to strengthening its independence and authority. During the 1970s, WHO had dropped its commitment to a global malaria eradication campaign as too ambitious, it retained a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. As of 2012,

2142-503: The World Health Organization was signed by all 51 countries of the United Nations, and by 10 other countries, on 22 July 1946. It thus became the first specialized agency of the United Nations to which every member subscribed. Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state. The WHO formally began its work in September 1, 1948. The first meeting of

2205-476: The absence of disease or infirmity." The main functions of the World Health Organization include: to promote the control of epidemic and endemic diseases; to provide and improve the teaching and training in public health, the medical treatment of disease and related matters; and to promote the establishment of international standards for biological products. The WHO was established on April 7, 1948, and formally began its work on September 1, 1948. It incorporated

2268-731: The assets, personnel, and duties of the League of Nations ' Health Organization and the Paris-based Office International d'Hygiène Publique , including the International Classification of Diseases (ICD). The agency's work began in earnest in 1951 after a significant infusion of financial and technical resources. The WHO's official mandate is to promote health and safety while helping the vulnerable worldwide. It provides technical assistance to countries, sets international health standards, collects data on global health issues, and serves as

2331-549: The backronym "everyone deserves a game above reproach". Many United States Congress bills have backronyms as their names; examples include the USA PATRIOT Act (Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act) of 2001, and the DREAM Act (Development, Relief, and Education for Alien Minors Act). Sometimes a backronym is reputed to have been used in

2394-577: The basis for global prevention, treatment, and support the plan to fight the AIDS pandemic . 2006: The WHO launches the Global action plan for influenza vaccines 2016: The Global action plan for influenza vaccines ends with a report which concludes that while substantial progress has been made over the 10 years of the Plan, the world is still not ready to respond to an influenza pandemic. 2016: Following

2457-478: The brand name Adidas , named after company founder Adolf "Adi" Dassler but falsely believed to be an acronym for "all day I dream about sport". The word Wiki is said to stand for "what I know is", but in fact is derived from the Hawaiian phrase wiki-wiki meaning 'fast'. Yahoo! , sometimes claimed to mean "yet another hierarchical officious oracle", in fact was chosen because Yahoo's founders liked

2520-424: The budget and activities. The WHO is funded primarily by contributions from member states (both assessed and voluntary), followed by private donors. Its total approved budget for 2020–2021 is over $ 7.2 billion, while the approved budget for 2022–2023 is over $ 6.2 billion. The budget is $ 6.83 billion for 2024–2025. The International Sanitary Conferences (ISC), the first of which was held on 23 June 1851, were

2583-627: The continuing effects of nuclear disasters in Chernobyl and Fukushima . They believe WHO must regain what they see as independence. Independent WHO held a weekly vigil from 2007 to 2017 in front of WHO headquarters. However, as pointed out by Foreman in clause 2 it states: In particular, and in accordance with the Constitution of the World Health Organization and the Statute of the International Atomic Energy Agency and its agreement with

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2646-601: The fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow. 2000: The Stop TB Partnership was created along with the UN's formulation of the Millennium Development Goals . 2001: The measles initiative was formed, and credited with reducing global deaths from the disease by 68% by 2007. 2002: The Global Fund to Fight AIDS, Tuberculosis and Malaria

2709-568: The formation of the original word, and amounts to a false etymology or an urban legend . Acronyms were rare in the English language before the 1930s, and most etymologies of common words or phrases that suggest origin from an acronym are false. Examples include posh , an adjective describing stylish items or members of the upper class. A popular story derives the word as an acronym from "port out, starboard home", referring to 19th-century first-class cabins on ocean liners , which were shaded from

2772-449: The global smallpox eradication campaign by contributing $ 2.4 million annually to the effort and adopted a new disease surveillance method, at a time when 2 million people were dying from smallpox per year. The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. The WHO also helped contain

2835-403: The infant's Apgar score should be reassessed at five-minute intervals for up to 20 minutes. Exceedingly few infants who have an Apgar score of 0 at 10 minutes of age survive with intact neurological function. As a result, the 2011 Neonatal Resuscitation Program suggests that if no pulse is appreciable at 10 minutes of life, "discontinuation of resuscitative efforts may be appropriate." However, in

2898-581: The initial publication, the backronym APGAR was coined in the US as a mnemonic learning aid: appearance, pulse, grimace, activity, and respiration. Another example is the American Contract Bridge League's tools to address cheating in online bridge games. EDGAR was originally named for Edgar Kaplan, whose many contributions to the game included groundbreaking efforts to reduce illegal partnership communication. The new EDGAR tools expected to debut in early 2024 have been launched with

2961-536: The last European outbreak in Yugoslavia in 1972 . After over two decades of fighting smallpox, a Global Commission declared in 1979 that the disease had been eradicated – the first disease in history to be eliminated by human effort. 1974: The Expanded Programme on Immunization and the control programme of onchocerciasis was started, an important partnership between the Food and Agriculture Organization (FAO),

3024-453: The late 20th century, the rise of new actors engaged in global health—such as the World Bank , the Bill & Melinda Gates Foundation, the U.S. President's Emergency Plan for AIDS Relief ( PEPFAR ) and dozens of public-private partnerships for global health—have weakened the WHO's role as a coordinator and policy leader in the field; subsequently, there are various proposals to reform or reorient

3087-477: The monitoring of public health risks, coordinating responses to health emergencies, and promoting health and well-being generally. The WHO is governed by the World Health Assembly (WHA), which is composed of its 194 member states. The WHA elects and advises an executive board made up of 34 health specialists; selects the WHO's chief administrator, the director-general (currently Tedros Adhanom Ghebreyesus of Ethiopia ); sets goals and priorities; and approves

3150-494: The mother during labor, gestational age or trauma. Inappropriately using the Apgar score has led to errors in diagnosing asphyxia. Various studies have shown that the Apgar score has variability between individual medical providers. One study was done in which several health care providers were assigned to give Apgar scores to the same infants. Results showed an Apgar score consistency of 55% to 82% between health care providers. Ideally, to limit variability and bolster consistency, it

3213-474: The other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement. The nature of this statement has led some groups and activists including Women in Europe for a Common Future to claim that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and

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3276-564: The perceived failure of the response to the West Africa Ebola outbreak , the World Health Emergencies programme was formed, changing the WHO from just being a "normative" agency to one that responds operationally to health emergencies. 2020: the World Health Organization announced that it had classified the novel coronavirus outbreak as a public health emergency of international concern. The novel coronavirus

3339-601: The risk of negative outcomes, it is recommended to obtain a sample of the umbilical artery blood gas when a newborn has an Apgar score of five or less at the five-minute mark. Recognizing the importance of skin to skin contact (SSC), the World Health Organization (WHO), as part of the Baby Friendly Hospital Initiative , recommends that the Apgar score should be done while SSC is underway whenever possible. This recommendation

3402-401: The sun on outbound voyages east (e.g. from Britain to India ) and homeward voyages west. The word's actual etymology is unknown, but more likely related to Romani påš xåra ('half-penny') or to Urdu (borrowed from Persian ) safed-pōśh ('white robes'), a term for wealthy people. Another example is the word chav , which is a derogatory term for a working-class youth. This word

3465-512: The word's meaning of "rude, unsophisticated, uncouth" (taken from Jonathan Swift 's book Gulliver's Travels ). The distress call " pan-pan " is commonly stated to mean "possible assistance needed", whereas it is in fact derived from the French word panne , meaning 'breakdown'. World Health Organization The World Health Organization ( WHO ) is a specialized agency of the United Nations responsible for global public health . It

3528-488: The world without prejudice to the right of the World Health Organization to concern itself with promoting, developing, assisting and co-ordinating international health work, including research, in all its aspects. The key text is highlighted in bold, the agreement in clause 2 states that the WHO is free to perform any health-related work. 1947: The WHO established an epidemiological information service via telex . 1949: The Soviet Union and its constituent republics quit

3591-513: Was a new strain of coronavirus that had never been detected in humans before. The WHO named this new coronavirus " COVID-19 " or "2019-nCov". 2022: The WHO suggests formation of a Global Health Emergency Council, with a new global health emergency workforce, and recommends revision of the International Health Regulations. 2024: WHO has declared the spread of mpox (formerly monkeypox) in several African countries

3654-460: Was adopted by the American Academy of Pediatrics in 2009. There are numerous factors that contribute to the Apgar score, several of which are subjective. Examples of subjective factors include but are not limited to color, tone, and reflex irritability. Preterm infants may receive a lower score in these categories due to lack of maturity rather than asphyxia. Other factors that may contribute to variability among infants are birth defects, sedation of

3717-543: Was concerning the compilation of accurate statistics on the spread and morbidity of disease. The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing. In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA), which says: whenever either organization proposes to initiate a programme or activity on a subject in which

3780-475: Was difficult to reach. Seven of these international conferences, spanning 41 years, were convened before any resulted in a multi-state international agreement. The seventh conference, in Venice in 1892, finally resulted in a convention. It was concerned only with the sanitary control of shipping traversing the Suez Canal , and was an effort to guard against importation of cholera. Five years later, in 1897,

3843-416: Was drawn up to improve the resources available. 2005: The WHO revises International Health Regulations (IHR) in light of emerging health threats and the experience of the 2002/3 SARS epidemic , authorizing WHO, among other things, to declare a health threat a Public Health Emergency of International Concern . 2006: The WHO endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed

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3906-705: Was formed. 1988: The Global Polio Eradication Initiative was established. 1995: The WHO established an independent International Commission for the Certification of Dracunculiasis Eradication (Guinea worm disease eradication; ICCDE). The ICCDE recommends to the WHO which countries fulfil requirements for certification. It also has role in advising on progress made towards elimination of transmission and processes for verification. 1998: The WHO's director-general highlighted gains in child survival, reduced infant mortality , increased life expectancy and reduced rates of "scourges" such as smallpox and polio on

3969-458: Was then published in Anesthesia & Analgesia in 1953. In 1955, efforts to establish a scientific basis to the score increased. Alongside Duncan Holaday and Stanley James, Apgar published a research paper using the scores of 15,348 infants to establish the association between a low Apgar score (0-2) and laboratory findings characteristics of asphyxia. The Apgar score is no longer used as

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