[HN Gopher] The Apgar Score helped decrease the infant mortality...
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The Apgar Score helped decrease the infant mortality rate
Author : allthebest
Score : 157 points
Date : 2021-01-20 21:48 UTC (1 days ago)
(HTM) web link (massivesci.com)
(TXT) w3m dump (massivesci.com)
| throwaway1239Mx wrote:
| https://www.newyorker.com/magazine/2006/10/09/the-score This is
| linked in OP, but gives very slightly more detail around how the
| score was actually popularized, and what Apgar's career looked
| like. (Plot twist, she wasn't "just" a practicing
| anesthesiologist, but the founder and head of a whole new
| Anesthesiology dept. at Columbia) I _think_ the short version is
| that she published a paper in 1953, and managed to get
| obstetricians using the scale in a competitive spirit, but I am
| still curious about how it was marketed (just publishing a paper
| is rarely enough to get something publicized, afaik).
|
| She also carried around a scalpel and tubing for giving passers-
| by emergency airways (tracheotomy?), and apparently did so over a
| dozen times.
| gumby wrote:
| > She also carried around a scalpel and tubing for giving
| passers-by emergency airways (tracheotomy?), and apparently did
| so over a dozen times.
|
| My mother does the same (well did, she's retired. She was an ER
| doctor). Before seatbelts and other safety devices were common
| there were a lot of gruesome accidents on the roads and we
| would have to stop. I remember several episodes were my sister
| and I were bored and annoyed because my mother had departed in
| the ambulance and my dad would drive us to the hospital to wait
| for her. Kid's perspective.
|
| I've been trained to do emergency procedures like a
| tracheotomy, move a patient with a back injury* et al and in my
| life have encountered _zero_ situations where my so-called
| "skills" would be useful. I don't even drive past many car
| accidents any more, nor have I ever seen a diner choke to the
| point where they needed assistance. But as a child I knew
| several kids who'd been hit by cars or fallen out of trees and
| been hospitalized, not to mention kids who'd lost a parent. Has
| the world become safer?
|
| * Obviously you only do this when the victim would be in even
| more and immediate danger where they are, else you leave 'em in
| place for the professionals.
| bobthepanda wrote:
| The world is safer, kind of, but we also now heavily
| discourage activities deemed to be unsafe, and may have erred
| too far in that direction.
|
| In the US, walking and biking to school has declined from
| nearly half in 1969 to 13% today. A Vancouver BC man recently
| won a lawsuit after he was taken through the child protective
| services wringer for letting his kids ride the bus
| unsupervised. While overall traffic deaths are down, the
| fatality rate for pedestrians is shooting up.
|
| We have basically created a world where only car travel is
| safe, and where we explicitly and implicitly encourage
| driving and discourage walking to get anywhere.
| matkoniecz wrote:
| One is really missing to me: how she convinced others to use the
| scoring system?
| bwood wrote:
| > The newborn's skin was blue and he wasn't breathing. A few
| years earlier, the doctors would have documented the baby as
| stillborn, not believing there was anything they could do to
| help.
|
| As someone who scored a 1/10 on the Apgar at birth, I'd like to
| thank Dr. Apgar for saving my life.
| hpoe wrote:
| As a father whose 3 children were all born emeregency c section
| and blue I also want to thank Dr. Apgar for the joy they have
| brought into my life.
| cjohnson318 wrote:
| My mom was born at an Air Force base in the 1950s. She said she
| was born silent and unresponsive, and they put her in another
| room to die, but then she recovered several hours later. That
| story always struck me as very odd, and heat breaking, but now
| it makes sense.
| okt2020 wrote:
| Is there a list of such scores by domain anywhere on the net i.e.
| name of the domain and the metrics applicable to it? e.g. for
| agricultural drought there is the palmer drought index
| [deleted]
| darkerside wrote:
| Gamification is nothing new, and can have big impacts
|
| > Implementing the Apgar score introduced a spirit of competition
| because the doctors inherently wanted the newborns they delivered
| to have better scores.
| carlmr wrote:
| Reading the responses of people here that survived with a score
| of 1/10 it really didn't matter what the score was. Only that
| it got doctors to compete to raise the score.
|
| It's a bit sad though that doctors apparently just didn't try
| to do anything about it before.
| dave_aiello wrote:
| My wife is a pediatrician. She uses Apgar Scores in evaluating
| babies weeks and months after birth. From what I understand, it's
| often useful to know the 1-minute and 5-minute Apgar Scores of an
| infant or young child, and specifically why they were scored less
| than 9/10 or 10/10, because some of these issues are germane to
| that child's future development.
| okt2020 wrote:
| Is there a single list of such scores by different domains as
| well as how they are computed? e.g. for drought severity we use
| the Palmer Drought Index
| duxup wrote:
| First time I opened that link I got a full screen scam ad about
| "Someone is stealing your data"....
|
| Here's an outline link:
|
| https://outline.com/VZBnSL
| tboyd47 wrote:
| > In the 1950s, reducing infant mortality (the death of an infant
| before their first birthday) was a daunting problem: an
| astonishing one in 30 newborns died at birth.
|
| > At that time, if a newborn didn't seem to be thriving - if, for
| example, the baby's skin was too blue or they were deemed too
| small - the baby would be left to die and documented as a
| stillborn.
|
| It sounds like the problem was that doctors were practicing
| applied eugenics.
| sillyquiet wrote:
| No, it sounds like you picked out a quote to make an edgy
| comment as you left out the _very_ next sentence.
|
| >Of course, it wasn't that anyone wanted these babies to die,
| but doctors simply believed that they were too sick to survive.
|
| i.e., they didn't want to prolong suffering.
| tboyd47 wrote:
| I consider the idea of doctors deciding who lives and who
| dies to be applied eugenics.
|
| "First, do no harm."
|
| Maybe that's not how the situation really looked on the
| ground, but that's what the author of the piece presents to
| us, and it wouldn't be strange for that time, either.
| sillyquiet wrote:
| That is a really dumb statement. Did I miss where the
| article said they were making this decision based on the
| genetics of the baby?
| tboyd47 wrote:
| This is not me trying to be edgy or snippy. During an era
| when eugenics was the predominant belief of the
| professional class in America, when they openly promoted
| "mercy killings" of certain classes of people, withheld
| treatment of deadly diseases from citizens on the basis
| of race, and sterilized thousands without their consent,
| and with all of this being so well-documented, no, I
| don't need the author to spell out the word "eugenics"
| for me to see it when it's written all over their
| actions.
|
| https://en.wikipedia.org/wiki/Eugenics_in_the_United_Stat
| es
| sillyquiet wrote:
| Leaving aside the dubious assertions there, you are
| inferring that all these doctors would prolong life
| saving measures for preferred classes while leaving non-
| preferred classes of people to die.
|
| Completely from inference. With no evidence. Nonsense.
| [deleted]
| matkoniecz wrote:
| Exactly the next sentence is
|
| "Of course, it wasn't that anyone wanted these babies to die,
| but doctors simply believed that they were too sick to
| survive."
| ultimoo wrote:
| > "blue all over" = 0
|
| > "blue at the extremities, body pink" = 1
|
| > "no cyanosis" = 2
|
| I wonder if they have updated guidance and training for scoring
| non-white babies. Brown and black babies probably don't turn blue
| in the same way white babies turn blue. In fact, a brown baby
| that's off color may appear to be a "healthy looking" - to the
| untrained eye - pink when in fact they should appear brown when
| healthy. I'd be curious to see mortality rate deviations for non-
| white babies vs. white babies (especially in non-metro areas that
| are more homogenous).
| sangnoir wrote:
| > Brown and black babies probably don't turn blue in the same
| way white babies turn blue.
|
| FYI: "Brown and black" babies are pretty pink at birth (or
| should be, when they have adequate oxygen).
| lqet wrote:
| > One of the most important symptoms of low blood oxygen
| concentrations in the newborn (hypoxia) is a change in skin
| colour, known as cyanosis. This is where the skin has a bluish
| hue. In dark skinned babies, this can be more difficult to see.
| For this reason, always inspect the mucous membranes (inside
| the mouth and the tongue) to determine if cyanosis is present.
| If you discover the mucous membranes are blue, this is known as
| central cyanosis.
|
| https://www.futurelearn.com/info/courses/neonatal-assessment...
| unfocused wrote:
| I know this score too well. Our second child scored a 2/10, as he
| was not breathing. My heart nearly stopped. But the nurses were
| quick to get to work, and all is well now, years later.
|
| I think simple, quick assessment tools, allow fast, correct
| reactions - which in this scenario is an absolute must.
| mcrider wrote:
| My daughter had the same score and experience two months ago.
| Scariest moment of my life -- But all is well now thanks to
| some amazing, fast moving doctors.
| fogleman wrote:
| BigQuery has a sample table, natality, that has all recorded
| births in the US from 1969 to 2008. It includes apgar_1min and
| apgar_5min fields.
|
| https://cloud.google.com/bigquery/public-data
|
| (Fun fact: I was actually able to find myself in the table based
| on my birthday, my birth state, my parent's ages and their birth
| states.)
| bomdo wrote:
| Having recently had a child, I learned about APGAR and marveled
| how the emotional "is my baby ok" was put into a super easy
| process. The chart from the article can be followed by absolutely
| anyone and babies can be sent to specialists as needed - or not.
| As the article mentions, it may not get everything 100% right,
| but it's useful enough - and more importantly easy enough - to
| save a lot of lives.
|
| I can highly recommend anyone to read about the process of
| medical emergency triage in general. It drastically reduces the
| knowledge needed to solve complex situations and gives you
| something to hold on to when things get hot. Seeing these
| stressful problems reduced to if-else flows was very
| inspirational for me for designing ways to tackle urgent issues
| in other areas of life, e.g. tech support, service requests or
| HR.
| cranekam wrote:
| > I can highly recommend anyone to read about the process of
| medical emergency triage in general
|
| Any recommendations? I had a search about but didn't find
| anything much beyond basic explanations of the term.
| ianmcgowan wrote:
| If you're in the US, a recommendation is to look up your
| local CERT[0] organization - they usually have free or low
| cost classes and other learning opportunities. Triage is an
| important part, as is preparing for disasters that are
| relevant for your community. Going further, a basic first aid
| and/or CPR class is good to get hands-on.
|
| [0] https://www.ready.gov/cert
| xattt wrote:
| Consider this chapter on assessment from the Trauma Nursing
| Core Course (1). The full provider manual may be hard to
| obtain, however.
|
| (1) https://notendur.hi.is/thorsj/gogn/TNCC.pdf
| kritiko wrote:
| Atul Gawande's Checklist Manifesto has some good discussions
| of complex care situations that are more or less driven by
| runbooks.
| lqet wrote:
| After my daughter was born, my parents showed me the booklet
| containing the results of the routine examinations I had as a
| child (where I come from, this booklet has been standardized
| for decades, so it can be compared pretty easily).
| Interestingly, we both had the exact same Apgar scores 6 / 10 /
| 10 (scores are measured 1, 5 and 10 minutes after birth).
|
| For the emotional "is my baby ok" aspect, before you are even
| interested in the Apgar scores, you automatically and
| instinctively do a quick "is everything there" check, even if
| you know that to be the case because of the ultrasound
| examinations.
| JshWright wrote:
| That's a pretty typical score progression (it's very rare for
| a baby to be a 10 right right out of the gate).
| saberdancer wrote:
| Isn't APGAR useful only for newborns?
| nibsfive wrote:
| Yes. It happens after birth. The paediatric nurse takes a
| look based on the checklist and ranks the baby out of 10. Our
| kid was an 8 but required NICU for the 2 they were missing.
| But if it's even lower they can immediately intervene, etc.
| rscho wrote:
| Indeed
| monkmartinez wrote:
| The ABC's are helpful for just about any emergent medical
| situation. From first responders to paramedics, we are hammered
| to remember and implement the ABC's. You can do a lot with very
| basic knowledge.
|
| Correcting problems with the systems associated with the ABC's
| is more knowledge and experienced based. A good basic first aid
| and CPR class will get you a lot of that knowledge. From there,
| staying calm and calling 911 is vital if you are US based.
|
| A - Airway / B - Breathing / C - Circulation
| marsvin wrote:
| It was great to hear him being 8/10 and soon up to 9/10. So
| comforting and removing all that unnecessary fear. Days and
| hours right before that moment were so exhausting that simple
| number was easy to process.
| asmithmd1 wrote:
| My father-in-law is a doctor and he jokingly told me when my
| daughter was born, that only the babies of doctors who work
| in the hospital get 10/10
| michael1999 wrote:
| And worsened maternal heath while deskilling obstetrics.
|
| https://www.newyorker.com/magazine/2006/10/09/the-score
|
| Blind Taylorism is dangerous. What we measure gets managed at the
| expense of unmeasured things.
| brazzy wrote:
| You may want to read that article more attentively, because it
| does not support your claim _at all_.
| joe-collins wrote:
| This is, I think, a good contrast to the "management by metrics"
| article currently sharing the front page. Attempting to govern
| through massive data or singular narrow measures each seen like
| folly. A broad, even vague, "directionally correct" measure is an
| excellent tool for keeping an enterprise aligned.
| thewarrior wrote:
| I've been thinking about this since I started working at a
| metrics driven company.
|
| One thing we often lose sight of is that metrics are coarse
| grained. Something like GDP for example is very good at telling
| you that the USA is a better place to live than Somalia. But it
| fails for more fine grained comparisons. We should refrain from
| doing micro optimizations on coarse grained metrics or ranking
| people on its basis unless the change is truly massive and
| validated.
|
| Metrics also need counter metrics. For GDP growth it maybe
| things like inequality, pollution, stress levels and so on.
|
| Metrics also need to continuously evolve as people understand
| their limitations.
|
| Metrics are a tool of social coordination and one of the most
| powerful ones to exist.
| Enginerrrd wrote:
| My personal opinion is that metrics should be largely
| invisible, only becoming visible at the level of management
| where decisions are made. Anything else leads to exactly what
| you just said: misguided micro-optimizations and
| gamesmanship.
| choeger wrote:
| GDP is an _excellent_ example, I think. Basically, it
| measures the total flow of wealth inside a country. If
| everyone behaves rationally this is a good proxy for wealth
| as a whole. But what happens if the government would setup a
| group of companies that trade immaterial or trivial products
| amongst each other at absurd prices? The faster that group
| trades, the higher the GDP. A metric has become a goal.
| TT3351 wrote:
| One issue with GDP: how do you define wealth? It's hard to
| incorporate more abstract assets like social trust or
| environmental conditions (latter can have direct impacts on
| things like tourism)
| redis_mlc wrote:
| Apples and oranges.
|
| The Apgar score isn't something that would normally be gamed,
| as it applies to a single infant.
|
| Whereas organizational metrics are nothing but games.
| pjc50 wrote:
| I think this might count as a "checklist" rather than a
| "metric", and crucially there aren't quite the same incentives
| to game the metric.
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