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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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Combined-Apgar: Relative risk for perinatal mortality.
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Fig2: Combined-Apgar: Relative risk for perinatal mortality.

Mentions: In 30% or 24% the Expanded-Apgar remained below 5 for up to 5 or 10 minutes, respectively. Less than 1% had an Expanded-Apgar below 3 for up to 5 or 10 minutes. The risk of poor outcome was below 30% in infants without any intervention; however, it increased to above 50% with a moderate (score 3–4) and above 60% with a low (score 0–2) Expanded-Apgar (see Additional file 1: Table A). For the Combined-Apgar, the relative risk of poor outcome increased with a decreasing score (see Additional file 3: Table I). As shown in Figure 2, a very low Combined-Apgar was associated with an about 30-fold increased risk for perinatal mortality.Figure 2


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)

Combined-Apgar: Relative risk for perinatal mortality.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Combined-Apgar: Relative risk for perinatal mortality.
Mentions: In 30% or 24% the Expanded-Apgar remained below 5 for up to 5 or 10 minutes, respectively. Less than 1% had an Expanded-Apgar below 3 for up to 5 or 10 minutes. The risk of poor outcome was below 30% in infants without any intervention; however, it increased to above 50% with a moderate (score 3–4) and above 60% with a low (score 0–2) Expanded-Apgar (see Additional file 1: Table A). For the Combined-Apgar, the relative risk of poor outcome increased with a decreasing score (see Additional file 3: Table I). As shown in Figure 2, a very low Combined-Apgar was associated with an about 30-fold increased risk for perinatal mortality.Figure 2

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