Published in:
Open Access
01-12-2015 | Research article
Neonatal assessment in the delivery room – Trial to Evaluate a Specified Type of Apgar (TEST-Apgar)
Authors:
Mario Rüdiger, Nicole Braun, Jacob Aranda, Marta Aguar, Renate Bergert, Alica Bystricka, Gabriel Dimitriou, Khaled El-Atawi, Sascha Ifflaender, Philipp Jung, Katarina Matasova, Violeta Ojinaga, Zita Petruskeviciene, Claudia Roll, Jens Schwindt, Burkhard Simma, Nanette Staal, Gloria Valencia, Maria Gabriela Vasconcellos, Maie Veinla, Máximo Vento, Benedikt Weber, Anke Wendt, Sule Yigit, Heinz Zotter, Helmut Küster, The TEST-Apgar study-group
Published in:
BMC Pediatrics
|
Issue 1/2015
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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 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.
Trial registration
clinicaltrials.gov Protocol Registration System (
NCT00623038). Registered 14 February 2008.