Neonatal assessment in the delivery room – Trial to Evaluate a Specified Type of Apgar (TEST-Apgar)

Abstract

BackgroundSince an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.MethodsScores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.ResultsOf 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7 ± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.ConclusionThe Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.Trial registrationclinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0334-7) contains supplementary material, which is available to authorized users.

Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

“…Furthermore, any measurement error in Apgar score might be expected to bias towards the null, potentially underestimating the association between Apgar score and ASN. Though modifications to the Apgar score have been proposed to address these shortcomings,38 these are not yet in widespread clinical use.…”

Predicting 2-y outcome in preterm infants using early multimodal physiological monitoring

“…Because of this limitation, we chose to include only physiological signals in the model in addition to GA, as GA is readily available. Clinical assessments such as Apgar scores were not considered in this study mainly because of this limitation on the number of explanatory variables; but also because of the subjective nature of the score and the fact that this score does not necessarily account for intervention performed in the delivery suite (27). With larger sample sizes, other clinical factors such as respiration, blood pressure, initial pH, lactate, and Apgar, could be explored for inclusion in the multivariate model.…”

Apgar Score Components at 5 Minutes: Risks and Prediction of Neonatal Mortality

“…Compared with the conventional Apgar score, information about Apgar score combined with information about neonatal interventions was recently reported to be a better predictor of birth asphyxia and severe asphyxia‐related neonatal morbidity . However, our aim was to study the risks and prognostic value of Apgar score components at 5 min regardless of preceding interventions.…”