Sir.—I read with interest the article by Davidson et al1 evaluating β-endorphin levels in low-birth-weight infants. The authors define severe perinatal asphyxia as "a one-minute Apgar score of 0 to 2 or the necessity at birth of positive pressure ventilation." A score of 3 to 4 was classified as mild to moderate asphyxia.
Numerous studies have shown that a low one-minute score does not correlate to either asphyxia or future outcome.2 Even a five-minute score of 0 to 3, although possibly due to hypoxia, has been shown to have limited value in this regard. Low-birth-weight infants studied by others have been shown to have low scores at birth secondary to neurologic immaturity without any evidence of asphyxia.3 A recent statement of the American Academy of Pediatrics2 on the use and misuse of Apgar scores states that because scores at one and five minutes have poor