Newborn Assessment in the Delivery Room

Abstract

A careful assessment of the postnatal condition of a newborn is mandatory. However, to assess the condition appropriately, the purpose of the assessment has to be known. The following three aims of assessing an infant’s postnatal condition are discussed: (1) To predict outcome and to perform clinical studies, an objective, numerical score is needed to describe the condition of groups of infants. The Combined Apgar consists of the Specified and the Expanded Apgar and allows a more detailed description of infant’s postnatal condition. Whereas the Specified Apgar describes the infant’s condition regardless of gestational age and interventions needed to achieve the condition, the Expanded Apgar gives a description of the administered interventions. (2) To guide interventions in clinical routine, a conceptual approach for assessing the postnatal condition in the individual infant is needed. The single items of the conventional Apgar score are a system of interdependent variables; respiration affects oxygenation (color), which affects heart rate and subsequently muscle tone and reflexes. Keeping the interdependency in mind helps to give the appropriate medical support. (3) To improve the quality of delivery room management in extremely preterm infants, a detailed description of the clinical condition, administered interventions with the subsequent response, and other environmental factors (team work, communication, technical parameters, etc) are needed. For that purpose, new technologies have demonstrated to be more reliable than clinical assessment to evaluate the classic Apgar parameters and on the other hand, uniform recordings of resuscitation interventions should be performed. In relation to this, video recording in the delivery room might help to register all these data as objectively as possible.