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

• Main Authors: Rüdiger, Mario, Braun, Nicole, Aranda, Jacob, Aguar, Marta, Bergert, Renate, Bystricka, Alica, Dimitriou, Gabriel, El-Atawi, Khaled, Ifflaender, Sascha, Jung, Philipp, Matasova, Katarina, Ojinaga, Violeta, Petruskeviciene, Zita, Roll, Claudia, Schwindt, Jens, Simma, Burkhard, Staal, Nanette, Valencia, Gloria, Vasconcellos, Maria Gabriela, Veinla, Maie, Vento, Máximo, Weber, Benedikt, Wendt, Anke, Yigit, Sule, Zotter, Heinz, Küster, Helmut
• Other Authors: TEST-Apgar study-group,
• Format: Article
• Language: English
• Published: Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden 2015
• Subjects: Apgar-Score; Postnataler Zustand; neonatale Beurteilung; TU Dresden; Publikationsfonds; Apgar score; Expanded-Apgar; Specified-Apgar; Postnatal condition; Neonatal assessment; Delivery room management; Preterm resuscitation; Technical University Dresden; Publication funds
• Online Access: http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-173501; http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-173501; http://www.qucosa.de/fileadmin/data/qucosa/documents/17350/R%C3%BCdigers12887-015-0334-7.pdf

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 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. 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.