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Observational Study
. 2015 Mar 8:15:18.
doi: 10.1186/s12887-015-0334-7.

Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar)

Mario Rüdiger  1 , Nicole Braun  2 , Jacob Aranda  3 , Marta Aguar  4 , Renate Bergert  5 , Alica Bystricka  6 , Gabriel Dimitriou  7 , Khaled El-Atawi  8 , Sascha Ifflaender  9 , Philipp Jung  10 , Katarina Matasova  11 , Violeta Ojinaga  12 , Zita Petruskeviciene  13 , Claudia Roll  14 , Jens Schwindt  15 , Burkhard Simma  16 , Nanette Staal  17 , Gloria Valencia  18 , Maria Gabriela Vasconcellos  19 , Maie Veinla  20 , Máximo Vento  21 , Benedikt Weber  22 , Anke Wendt  23 , Sule Yigit  24 , Heinz Zotter  25 , Helmut Küster  26 ; TEST-Apgar Study-Group
Affiliations
Observational Study

Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar)

Mario Rüdiger et al. BMC Pediatr. .

Abstract

Background: 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; 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.

Methods: Scores 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.

Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) 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.

Conclusion: The 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 registration: clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.

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Figures

Figure 1
Figure 1
Distribution-pattern of the Specified-Apgar (A, B) and Expanded-Apgar (C, D) at 1 and 10 minutes. In the boxplot, the central box represents the values from the lower to upper quartile (25 to 75 percentile). The middle line represents the median. The vertical line extends from the minimum to the maximum value. Outlier values are displayed as black dots, extreme values are displayed as an asterix.
Figure 2
Figure 2
Combined-Apgar : Relative risk for perinatal mortality.
See this image and copyright information in PMC

References

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