In 1952, Dr. Virginia Apgar, an anesthesiologist working with obstetric patients, developed a test she used to quickly assess a newborn’s health. The test, which became known as the Apgar score, is used around the world to summarize newborn health at one and five minutes after birth. The five measures of health correlate to Dr. Apgar’s name:

A — Appearance / Complexion
P — Pulse Rate
G — Grimace / Reflex
A — Activity
R — Respiratory Effort

On each measure, a child is graded as 0 (poor), 1, or 2 (robust) and the grades for each measure are added to formulate a score. A score of 10 is the highest possible. Low scores indicate the need for immediate medical intervention.

Physicians and other medical personnel have relied on the Apgar score for decades and many babies born in distress have gone home healthy as a result of the immediate attention they got as a result of their Apgar scores. One measure on the test, however, is raising concerns. Some doctors are so concerned they’re calling for a reassessment of the criteria used for newborn evaluation.

The “A for Appearance” measurement doesn’t translate to babies of color as effectively as it needs to, according to Drs. Brandi N. Adams and Amos Grünebaum. The results of a study they conducted using hospital personnel has been published in the May 2014 issue of the journal, Obstetrics & Gynecology.

Babies born blue or pale all over their bodies could be suffering the effects of low oxygen in their bloodstream (earning a 0 Apgar score for the appearance measure). A baby who is pink all over is thought to be healthy and earns an Apgar score of 2 for appearance. It’s not unusual for a score to be low in the one-minute test and higher in the five-minute test.

The Adams-Grünebaum survey study involved 61 participants:

  • 23 were nurses
  • 25 were physicians
  • 13 were other Apgar-trained medical personnel

The researchers discovered:

  • 32.8% incorrectly identified the purpose of Apgar scores
  • 29.5% were wrong about the test’s most important components
  • 34.4% said the baby’s ethnicity was considered during testing
  • 57.4% said “pink” does not accurately describe the complexion of newborn African Americans who test healthy in other Apgar measures

Adams and Grünebaum suggest confusion over the color component of the test, especially when assessing children of color, which leads to scores lower than appropriate. They suggest the standard description of “pink all over” is in need of reassessment so that more accurate scores can be made of all newborns, especially those whose natural skin tone is more darkly pigmented than others.

Source: Adams, Brandi N, MD, and Amos Grünebaum, MD. “Does ‘Pink All Over’ Accurately Describe an Apgar Color Score of 2 in Newborns of Color? (abstract)” Obstetrics & Gynecology. The American College of Obstetricians and Gynecologists. Apr 28, 2014. Web. May 9, 2014.