Torday John S, Nielsen Heber C
Pediatrics, Harbor - UCLA Medical Center , Torrance, CA , USA.
Tufts Medical Center , Boston, MA , USA.
Front Pediatr. 2017 Mar 20;5:45. doi: 10.3389/fped.2017.00045. eCollection 2017.
One of the first "tools" used for systematically evaluating successful newborn transitional physiology at birth was the Apgar Score, devised by Virginia Apgar in 1953. This objective assessment tool allowed clinicians to immediately gauge the relative success of a newborn infant making the transition from the liquid immersive environment to the gas environment in the delivery room during the first minutes after birth. The scoring system, although eponymous, is generally summarized as an acronym based on Appearance, Pulse, Grimace, Activity, and Respiration, criteria evaluated and scored at 1 and 5 min after birth. This common clinical appraisal is a guide for determining the elements of integrated physiology involved as the infant makes the transition from a "sea water" environment of 3% oxygen to a "land" environment in 21% oxygen. determines the perfusion of the skin with oxygenated blood-turning it pink; is the rate of heart beat, reflecting successful oxygen delivery to organs; , or irritability, is a functional marker for nervous system integration; represents locomotor capacity; and, of course, represents pulmonary function as well as the successful neuro-feedback-mediated drive to breathe, supplying oxygen by inspiring atmospheric gas. Respiration, locomotion, and metabolism are fundamental processes adapted for vertebrate evolution from a water-based to an atmosphere-based life and are reflected by the Apgar Score. These physiologic processes last underwent major phylogenetic changes during the water-land transition some 300-400 million years ago, during which specific gene duplications occurred that facilitated terrestrial adaptation, in particular the parathyroid hormone-related protein receptor, the β-adrenergic receptor, and the glucocorticoid receptor. All these genetic traits and the gene regulatory networks they comprise represent the foundational substructure of the Apgar Score. As such, these molecular elements can be examined using a Molecular Apgar evaluation of keystone evolutionary events that predict successful evolutionary adaptation of physiologic functions necessary for neonatal transition and survival.
1953年由弗吉尼亚·阿普加设计的阿普加评分是最早用于系统评估新生儿出生时成功过渡到生理状态的“工具”之一。这个客观评估工具使临床医生能够在出生后的头几分钟内，立即判断新生儿在产房从液体浸泡环境过渡到气体环境的相对成功程度。该评分系统虽然以人名命名，但通常以首字母缩写来概括，这些首字母代表外观、脉搏、 grimace（对刺激的反应）、活动和呼吸，这些标准在出生后1分钟和5分钟进行评估和评分。这种常见的临床评估是确定婴儿从含3%氧气的“海水”环境过渡到含21%氧气的“陆地”环境时所涉及的综合生理要素的指南。外观（Appearance）决定了含氧血液对皮肤的灌注，使其变为粉红色；脉搏（Pulse）是心跳速率，反映了向器官成功输送氧气； grimace（对刺激的反应），即易激惹性，是神经系统整合的功能指标；活动（Activity）代表运动能力；当然，呼吸（Respiration）代表肺功能以及成功的神经反馈介导的呼吸驱动力，通过吸入大气中的气体来提供氧气。呼吸、运动和新陈代谢是脊椎动物从水生生活向大气生活进化过程中适应的基本过程，阿普加评分反映了这些过程。这些生理过程在大约3亿至4亿年前的水陆过渡期间经历了重大的系统发育变化，在此期间发生了特定的基因复制，促进了陆地适应，特别是甲状旁腺激素相关蛋白受体、β-肾上腺素能受体和糖皮质激素受体。所有这些遗传特征及其组成的基因调控网络代表了阿普加评分的基础子结构。因此，可以使用分子阿普加评估来检查这些分子元素，该评估针对关键的进化事件，这些事件预测了新生儿过渡和生存所需生理功能的成功进化适应。
