The Successful Immediate Neonatal Transition to Extrauterine Life

Michel, Alexandra; Lowe, Nancy K.

doi:10.1177/1099800416685178

Cited by 10 publications

(8 citation statements)

References 60 publications

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“…It is easy to use and teach 6. Further, assigning the Apgar score at birth is embedded in clinical practice and a routine part of clinical documentation 16. Therefore, the Apgar score has adequate face validity.…”

Section: Resultsmentioning

confidence: 99%

“…15 Currently, the Apgar score is assigned at basically every birth. 16 The data are stored in large datasets allowing easy access even years later. These facts combined with a lack of critical appraisal of the score's strengths and weaknesses may be one reason for its indiscriminate use in research.…”

mentioning

confidence: 99%

“…Currently, the Apgar score is assigned at basically every birth 16. The data are stored in large datasets allowing easy access even years later.…”

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confidence: 99%

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Review of the Reliability and Validity of the Apgar Score

Michel

2022

Advances in Neonatal Care

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Background: The Apgar score is the most common score used to quantify neonatal status after birth. It is routinely used in clinical practice and research. However, since its introduction there have been significant changes in peripartum and neonatal management, our understanding of neonatal physiology, and changes in data analysis capabilities. Purpose: To assess the Apgar score's reliability and validity in the context of today's clinical and research environments. Method: PubMed was searched using the term “Apgar.” Just over 22,000 titles were identified. Full-text articles were obtained if they addressed the Apgar score's use, reliability, and validity, or if the score was a primary outcome measure. This was followed by a hand search using the same criteria. The 505 identified articles build the basis for this discussion of the Apgar score's reliability and validity. Findings: Multiple positive and negative aspects of the Apgar score's reliability and validity were identified. Some facets needed to evaluate reliability and validity do not seem to have been addressed in the literature. Overall, the identified concerns can introduce bias into outcomes obtained via the use of the Apgar score in both clinical practice and research. Implications for Practice: The Apgar score is no longer used to determine neonatal management in the delivery room. Implications for Research: The use of the Apgar score in research may introduce bias into outcomes. As discussed in the Video Abstract, researchers need to address and improve the score's weaknesses or consider developing a new tool better suited to today's research needs. Video Abstract available at: https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=45

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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Review of the Reliability and Validity of the Apgar Score

Michel

2022

Advances in Neonatal Care

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“…Neonates with a respiratory effort between these two extremes should receive 1 point. However, breathing effort or even crying are not synonymous with oxygenation (Michel & Lowe, 2017). NRP recommends the use of pulse oximetry to assess neonatal oxygenation status (Weiner, 2021) which is a hidden task characteristic and thus requires additional resources to be assessed.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Interrater Agreement of Registered Nurses’ Assignment of Apgar Scores to Standardized Clinical Vignettes

Michel

Lowe²

2023

Clin Nurs Res

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The purpose of our study was to test whether registered nurses assign the correct Apgar score when provided all pertinent data, whether they assign an Apgar score even if all pertinent data are not provided, and to evaluate the Apgar score’s interrater agreement. We conducted a REDCap survey and provided nurses with color photograph/vignette combinations of neonates, some of which lacked pertinent data points needed to correctly assign Apgar scores. Over 90% of study participants assigned Apgar scores even if data points for heart rate or respiratory effort were omitted. Participants’ correct assignment of the component score for respiratory effort was affected by the description of the respiratory effort and whether neonatal heart rate was known. Interrater agreement was generally low to moderate. Our findings are consistent with earlier findings and support the conclusion that the Apgar score requires significant revision or needs to be retired and replaced.

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“…Parturition is a complex process that requires a series of coordinated events, whose final objective is the transition to extrauterine life. These events range from cellular and molecular modifications of the myometrium and cervix, to cardiorespiratory, endocrine and homeostatic adaptations experienced by the fetus in a short period of time (Feifel et al, 2015; Michel & Lowe, 2017). The fetus is well adapted to the relatively hypoxemic intrauterine environment.…”

Section: The Transition To Extrauterine Life Is a Major Factor In The...mentioning

confidence: 99%

Transition to extrauterine life and the modeling of perinatal asphyxia in rats

Ortiz

Loidl

Vazquez

2022

WIREs Mechanisms of Disease

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Generation of murine models for the study of birth‐related pathologies has proven to be a complex and controversial problem. Differences in the relative timing of developmental events of both species have led some researchers to suggest that the rat is born comparatively less developed than the human. The solution proposed to this problem would consist in the delay of the experiments of perinatal asphyxia (PA), usually up to 7–10 days, allowing developmental levels to “equalize” with the human at birth. This solution generates a new set of problems. The developmental milestones in both species follow a divergent temporal pattern. Increasing the age of the rat not only can improve resemblance with humans but also will make the model miss a crucial set of milestones related to birth. During this process, there are specific mechanisms to protect the fetus from neuronal damage, especially those caused by asphyxia. These factors are not present in models where the asphyxia is delayed. In these models, there will be more false positives and more damage that would not be present in humans exposed to PA. This article is categorized under: Cancer > Stem Cells and Development Congenital Diseases > Environmental Factors Neurological Diseases > Environmental Factors

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The Successful Immediate Neonatal Transition to Extrauterine Life

Cited by 10 publications

References 60 publications

Review of the Reliability and Validity of the Apgar Score

Review of the Reliability and Validity of the Apgar Score

Accuracy and Interrater Agreement of Registered Nurses’ Assignment of Apgar Scores to Standardized Clinical Vignettes

Transition to extrauterine life and the modeling of perinatal asphyxia in rats

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