A pioneer of neonatology

Have you ever come across the word “backronym”? First cited in a 1983 Washington Post column, it is a portmanteau word derived from “back” and “acronym”.

It is defined as a “reverse acronym”, in which a word that already exists has been turned into an acronym by the choice of appropriate words to fit each of its letters.

One of the best examples of a backronym is Apgar. The Apgar score is a rapid method of assessing the health of a newborn child and determining whether it needs special attention to stay alive. The system has helped reduce infant mortality all over the world.

The scoring system involves a quick assessment of five simple criteria, each beginning with one of the letters of the word Apgar — appearance (skin colour), pulse (heart rate), grimace (reflex response), activity (muscle tone) and respiration.

Each criterion is rated from 0 to 2, with a total score of 10 signifying the best possible physical condition. The assessment is carried out one minute and five minutes after birth.

Why Apgar? The scoring system was developed around 1950 by US physician Virginia Apgar, who was a specialist in anaesthesia and paediatrics and a pioneer of neonatology. After years of studying the effects of anaesthesia in childbirth, she realised the need for a simple, rapid and accurate evaluation of a newborn baby’s health and created what she called the “newborn scoring system”.

But that name did not stick because some 10 years later another physician devised the backronym so that Apgar’s own name could be used as a learning aid. The mnemonic was so successful that it has been used ever since.

Tomorrow (7 June 2009) is the centenary of Virginia Apgar’s birth. After attending a prestigious women-only college in Massachusetts, she was among the first women to be admitted to New York’s Columbia University College of Physicians and Surgeons. She was one of the first US women to specialise in surgery but then decided to move to anaesthesiology.

Her groundbreaking work in that field led to her appointment as director of anaesthesiology at Columbia, the first woman to head a department at the university. In 1949 she became the first full professor of anaesthesiology and the first woman to hold a full professorship in any discipline at Columbia.

At the age of 50 her career changed again when she became a senior executive with the March of Dimes Foundation, a national charity with a mission to improve the health of babies by preventing birth defects, premature births and infant mortality. She had great success in generating public support and raising funds for research.

She received many honours in her lifetime, and they continued to be awarded long after her death in 1974. In 1994 she was commemorated on a US postage stamp, as part of a series on great Americans, and shortly afterwards she was inducted into the National Women’s Hall of Fame.

Virginia Apgar was a brilliant physician and humanitarian, and a great role model for women in health care — and for men too, for that matter.