{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T03:03:21Z","timestamp":1781147001790,"version":"3.54.1"},"reference-count":25,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:p>Apgar scores are universally recorded, but they should no longer be used to guide resuscitation; thus, some authorities have suggested that the scores should be abandoned. However, the physiological relationships underlying the elements of the Apgar scoring system can be conceptualised as a cycle, wherein the five functions are linked by cardiorespiratory reflexes and metabolically supported by the oxygen pathway. Respiratory effort represents both the main input into the system and its functional output (sustained respirations). The progressive deterioration of functions during asphyxia, and their recovery during resuscitation, are readily understood within the sequence. This depiction helps in learning concepts such as primary and secondary apnoea and bradycardia. The visual model harmonises the pedagogical and practical values of the Apgar scoring system, by placing the rapid assessment of respirations, heart rate and colour during neonatal resuscitation (as taught in the Neonatal Resuscitation Program) in its broader physiological context. The understanding imparted by the Apgar cycle may directly enhance patient care during resuscitation, apart from the attribution of numerical scores.<\/jats:p>","DOI":"10.1136\/adc.2008.145037","type":"journal-article","created":{"date-parts":[[2008,8,14]],"date-time":"2008-08-14T20:34:42Z","timestamp":1218746082000},"page":"F70-F72","source":"Crossref","is-referenced-by-count":22,"title":["The Apgar cycle: a new view of a familiar scoring system: Figure 1"],"prefix":"10.1136","volume":"94","author":[{"given":"J M B","family":"Pinheiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2008,8,14]]},"reference":[{"key":"2025090513460142000_94.1.F70.1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1213\/00000539-195301000-00041","article-title":"A proposal for a new method of evaluation of the newborn infant.","volume":"32","author":"Apgar","year":"1953","journal-title":"Anesth Analg"},{"key":"2025090513460142000_94.1.F70.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1958.03000150027007"},{"key":"2025090513460142000_94.1.F70.3","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1962.02080030421015"},{"key":"2025090513460142000_94.1.F70.4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1542\/peds.68.1.36","article-title":"Apgar scores as predictors of chronic neurologic disability.","volume":"68","author":"Nelson","year":"1981","journal-title":"Pediatrics"},{"key":"2025090513460142000_94.1.F70.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102153440701"},{"key":"2025090513460142000_94.1.F70.6","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.114694"},{"key":"2025090513460142000_94.1.F70.7","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.109608"},{"key":"2025090513460142000_94.1.F70.8","first-page":"203","article-title":"The inaccuracy of Apgar scoring.","volume":"8","author":"Clark","year":"1988","journal-title":"J Perinatol"},{"key":"2025090513460142000_94.1.F70.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38117.665197.F7"},{"key":"2025090513460142000_94.1.F70.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2006.05.040"},{"key":"2025090513460142000_94.1.F70.11","unstructured":"American College of Obstetricians and Gynecologists. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology. 2003. http:\/\/www.acog.org\/from_home\/Misc\/neonatalEncephalopathy.cfm (accessed 20 Oct 2008)."},{"key":"2025090513460142000_94.1.F70.12","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1542\/peds.78.6.1148","article-title":"Use and abuse of the Apgar score.","volume":"78","author":"American Academy of Paediatrics Committee on Fetus and Newborn","year":"1986","journal-title":"Pediatrics"},{"key":"2025090513460142000_94.1.F70.13","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-0325"},{"key":"2025090513460142000_94.1.F70.14","unstructured":"American Academy of Pediatrics\/American Heart Association. Neonatal resuscitation textbook. 5th edn. Elk Grove Village, IL: American Academy of Pediatrics\/American Heart Association, 2006:1\u201314."},{"key":"2025090513460142000_94.1.F70.15","first-page":"591","article-title":"Is the Apgar score outmoded?","volume":"1","year":"1989","journal-title":"Lancet"},{"key":"2025090513460142000_94.1.F70.16","doi-asserted-by":"publisher","DOI":"10.1136\/adc.67.7_Spec_No.765"},{"key":"2025090513460142000_94.1.F70.17","doi-asserted-by":"crossref","unstructured":"Drew D . ABCD not APGAR. BMJ Jul 2004; 329 (7458). http:\/\/bmj.bmjjournals.com\/cgi\/eletters\/329\/7458\/143#69098 (accessed 20 Oct 2008).","DOI":"10.1136\/bmj.38117.665197.F7"},{"key":"2025090513460142000_94.1.F70.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102153440709"},{"key":"2025090513460142000_94.1.F70.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1962.03050300073025"},{"key":"2025090513460142000_94.1.F70.20","unstructured":"Calmes SH . And what about the baby? Virginia Apgar and the Apgar score. ASA Newsletter Sep 1997. http:\/\/apgar.net\/virginia\/Selma4.html (accessed 20 Oct 2008)."},{"key":"2025090513460142000_94.1.F70.21","unstructured":"Dawes GS . Foetal and neonatal physiology. Chicago: Year Book Medical Publishers, Inc 1968:141\u201359."},{"key":"2025090513460142000_94.1.F70.22","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/S0140-6736(79)91218-2","article-title":"Role of carotid-body chemoreceptors and their reflex interactions in bradycardia and cardiac arrest.","volume":"1","author":"Daly","year":"1979","journal-title":"Lancet"},{"key":"2025090513460142000_94.1.F70.23","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1113\/jphysiol.1978.sp012152","article-title":"The effects of artificial lung inflation on reflexly induced bradycardia associated with apnoea in the dog.","volume":"274","author":"Angell-James","year":"1978","journal-title":"J Physiol (Lond)"},{"key":"2025090513460142000_94.1.F70.24","unstructured":"Benitz WE Sunshine P . Neonatal resuscitation. In: Nelson N M , ed. Current therapy in neonatal-perinatal medicine. 1st edn. Toronto: BC Decker, 1985:360\u201370."},{"key":"2025090513460142000_94.1.F70.25","unstructured":"Goldsmith JP . Assessing the depressed neonate: clues to etiology and necessary interventions. Neonatal Resuscitation Program 2006. http:\/\/www.aap.org\/nrp\/pdf\/DepressedNeonate.pdf (accessed 20 Oct 2008)."}],"container-title":["Archives of Disease in Childhood - Fetal and Neonatal Edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/adc.2008.145037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T20:46:11Z","timestamp":1757105171000},"score":1,"resource":{"primary":{"URL":"https:\/\/fn.bmj.com\/lookup\/doi\/10.1136\/adc.2008.145037"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,8,14]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2008,12,22]]},"published-print":{"date-parts":[[2009,1]]}},"alternative-id":["10.1136\/adc.2008.145037"],"URL":"https:\/\/doi.org\/10.1136\/adc.2008.145037","relation":{},"ISSN":["1359-2998","1468-2052"],"issn-type":[{"value":"1359-2998","type":"print"},{"value":"1468-2052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,8,14]]}}}