787 MORE ON APGAR SCORE (AS) AND ASPHHIA (ASPH)

Abstract

We examined the relationship between AS and biochemical asph using 2 observers (obs). Obs 1 was aware of antepartum history, obs 2 exposed to the infant at the time of delivery. Obs changed roles after every 10th delivery. Independent AS's were assigned at 1 and 5 mins. Curing their 5 minute period of observation, obs predicted outcome as: normal; grade la asph (2 of pH <7, 20, bicarb <16mmol/l, base deficit >10); grade Ib (Ia + >5 mins to spontaneous respiration); grade II (Ib + clinical signs; seizures, lethargy, etc). Cord blood gas (CBG) was taken at delivery and later compared with AS and predicted outcome. Thirty five term deliveries were studied. Using the above criteria, 10 were Ia asph on subsequent CBG analysis; 3 were Ib; 22 were normal. The correlation coefficient for interobserver AS was r=.97 at 1 and 5 mins, and obs agreed on predicted outcome in 97% of cases. However, obs correctly predicted only 25% of asph and 62% of normals. The obs AS correlated with delivery room staff assessment of need for positive pressure resuscitation (PPR). All obs AS's of <5 at 1 min had PPR vs only 2 of 26 with AS 5, however CBG results suggest that PPR was for primary apnea in 55%. We conclude : 1) the previously demonstrated poor correlation between AS and biochemical asph is not improved by an awareness of antenatal events; 2) neither AS nor apparent need for PPR are reliable indicators of asph; 3) strict definition is required in studies reporting long term outcome of asphyxia.