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.
Highlights
Since 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; describes the condition regardless of gestational age (GA) or resuscitative interventions
We suggested to specify the items of the conventional Apgar and to score infant’s condition regardless of gestational age and interventions (Specified-Apgar) [5]
Data After birth, the following data were collected by the attending neonatologist: gestational age, birth weight, mode of delivery and a description of the infant at 1, 5 and 10 minutes of life according to the definition of the Combined-Apgar, which consists of the Expanded-Apgar and Specified-Apgar as shown in Table 1: 1. Specified-Apgar [5]: Muscle tone and reflex response were evaluated in relation to GA as being appropriate
Summary
Since 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; 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. To describe the postnatal condition of groups of infants or to compare effects of interventions in a research setting a numerical score, which represents the sum of several objective findings is required. To better differentiate between both conditions, the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) suggested to score and document the interventions that are required to achieve the condition (Expanded-Apgar) [6]. It can be assumed that an infant’s condition is better described using both scores (Combined-Apgar) simultaneously than one score alone
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