Abstract
ObjectivesTo compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes.MethodsThis prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure.ResultsThe Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01).ConclusionsThe newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.
Highlights
When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of hypoxic Ischemic Encephalopathy (HIE) (B = 1.61, P = 0.02) and intraventricular hemorrhage (IVH) (B = 2.8, P = 0.01)
The ACOG in the committee opinion on Apgar score, stated that a low Apgar score beyond 5 minutes is a suggestive criterion for asphyxia, there are several limitations with the Apgar score that make it inappropriate to be used alone for establishing the diagnosis of asphyxia, or for predicting the adverse neonatal outcomes.[8]
The Specified-Apgar and later the Expanded-Apgar scores were suggested to allow the assessment of the newborn's condition independent of the interventions and the gestational age. [8,10,11] Despite these advances, there was still a need for a more comprehensive and precise scoring system that could predict the occurrence of adverse neonatal outcomes
Summary
Apgar scoring system which was described in 1950s, is the oldest and most commonly used assessment tools for the evaluation of the newborn and the need for interventions in the delivery room.[4] In addition some studies used the Apgar score for the assessment of birth asphyxia and the prediction of adverse neonatal outcomes.[5,6,7]. The ACOG in the committee opinion on Apgar score, stated that a low Apgar score beyond 5 minutes is a suggestive criterion for asphyxia, there are several limitations with the Apgar score that make it inappropriate to be used alone for establishing the diagnosis of asphyxia, or for predicting the adverse neonatal outcomes.[8] Apgar score is influenced by the gestational age, neonate's maturity, drugs, etc. The Specified-Apgar and later the Expanded-Apgar scores were suggested to allow the assessment of the newborn's condition independent of the interventions and the gestational age. The Combined-Apgar score was proposed by Rüdiger et al that consists of both the Specified and the Expanded Apgar scores to allow a more detailed description of neonate's postnatal condition.[12]
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