July 3, 1974
Dear Doctor Ikonen:
Never before has a doctoral thesis been written about the newborn scoring system which I reported in 1952!  I do hope it helped you attain your degree, and not the opposite.
It interests me to read how often the scoring system is expected to forecast conditions for which it was never intended.  As stated in 1953, the system was devised, as described on page 260 of your reference #7, "as a basis for discussion and comparison of the results of obstetric practices, types of materna1 pain relief and the effects of resuscitation."  Actually, its uses were: 1) to predict infant mortality and 2) to point out to the physician the need for active resuscitation if the total score vas four or less.
Now, 22 years later, the score is being examined for association with I.Q. at school age, behavioral disorders, fatal infant diseases such as Tay-Sachs, autism, and length of time in the intensive care unit!  I would not expect that there would be either a positive or negative association with these parameters.  However, it does no harm at all to investigate under what conditions the score is useful or useless.
Dr. Erich Saling of West Berlin, who has quantitated the degree of asphyxia and acid-base balance, and I are attempting to combine our methods and hope to have something published soon.
Thank you for the autographed thesis.  Please give my best regards to Dr. Ahvenainen.  I had hoped to visit you during the Helsinki meeting of the European Teratology Society, but had to go to California instead.
With best wishes.
Sincerely yours,
Virginia Apgar, M.D., M.P.H.