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

Rüdiger M, Braun N, Aranda J, Aguar M, Bergert R, Bystricka A, Dimitriou G, El-Atawi K, Ifflaender S, Jung P, Matasova K, Ojinaga V, Petruskeviciene Z, Roll C, Schwindt J, Simma B, Staal N, Valencia G, Vasconcellos MG, Veinla M, Vento M, Weber B, Wendt A, Yigit S, Zotter H, Küster H, TEST-Apgar Study-Gro - BMC Pediatr (2015)

Bottom Line: Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. mario.ruediger@uniklinikum-dresden.de.

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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Related in: MedlinePlus

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.
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Fig1: 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.

Mentions: The postnatal condition during the first minute of life showed a linear correlation with gestational age; with the Specified-Apgar scoring higher at higher gestational age (Figure 1A). In contrast, there was no linear correlation between gestational age and medical interventions (Expanded-Apgar) at one minute; medical support was almost similar for infants below 28 weeks of gestation (Figure 1C).Figure 1


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

Rüdiger M, Braun N, Aranda J, Aguar M, Bergert R, Bystricka A, Dimitriou G, El-Atawi K, Ifflaender S, Jung P, Matasova K, Ojinaga V, Petruskeviciene Z, Roll C, Schwindt J, Simma B, Staal N, Valencia G, Vasconcellos MG, Veinla M, Vento M, Weber B, Wendt A, Yigit S, Zotter H, Küster H, TEST-Apgar Study-Gro - BMC Pediatr (2015)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374498&req=5

Fig1: 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.
Mentions: The postnatal condition during the first minute of life showed a linear correlation with gestational age; with the Specified-Apgar scoring higher at higher gestational age (Figure 1A). In contrast, there was no linear correlation between gestational age and medical interventions (Expanded-Apgar) at one minute; medical support was almost similar for infants below 28 weeks of gestation (Figure 1C).Figure 1

Bottom Line: Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. mario.ruediger@uniklinikum-dresden.de.

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.

Show MeSH
Related in: MedlinePlus