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Apgar scores are determined for every neonate born in a U.S. hospital. Despite the frequency with which the scores are calculated, they are not always accurate. In addition, some individuals attempt to use the scores to substantiate certain claims, such as birth asphyxia. This article discusses some of the common misunderstandings and limitations of the Apgar score and suggests measures for improvement.
In this prospective study, we investigated the relation between the Apgar and Sigtuna scores in 1605 newborns. In 169 of them, umbilical arterial blood specimens were analysed for blood gases. There were significant correlations between the Sigtuna and Apgar scores at 1, 5 and 10 minutes after birth (P less than 0.001). Umbilical arterial blood pH (pHua) values were shown to be correlated with both the Sigtuna and Apgar scores. The Sigtuna score was similar to the Apgar score in respect of sensitivity, specificity, positive predictive value and negative predictive value in relation to pH level. We conclude that because of the simplicity of the Sigtuna score, it may be used in place of the Apgar score to establish a rapid diagnosis of asphyxia.
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AIM: To examine the relationship between neonatal auditory function and Apgar score in term infants with depressed Apgar scores. METHODS: Brainstem auditory evoked response (BAER) was recorded on day 3 after birth in term infants who had Apgar scores < or = 7 at 1 and/or 5 min. Half of the infants also had Apgar scores at 10 min, with 17 < or = 7. RESULTS: No BAER variables correlated significantly with 1-min Apgar score. However, wave III and V latencies, and I-V, I-III and III-V intervals correlated significantly and negatively with 5-min Apgar score (p < 0.05-0.01). These BAER variables were significantly longer in infants with 5-min Apgar scores < or = 7 than those > 7. Wave V latency and all intervals also correlated negatively with 10-min Apgar score (p < 0.05-0.01). Compared to normal controls, all latencies were prolonged in infants with depressed Apgar scores (all p < 0.05-0.01). All intervals were also prolonged in those with 5-min scores < or = 7 (p<0.05-0.01). Similar results were found when defining the depression of Apgar score as < or = 6. CONCLUSION: A depressed 5- and/or 10-min Apgar score is an indicator associated with neonatal auditory, mainly central, impairment. Apgar score < or = 7 or 6 at 1 min alone is unlikely to be associated with central impairment.
The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.
The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.
The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.
OBJECTIVE: Apgar scores and cord blood gases (BG) and pH were compared between a group of babies with nuchal cords and a group without nuchal cords and uncomplicated deliveries. STUDY DESIGN: We collected umbilical arterial (UA) and umbilical venous (UV) blood samples from the placentas of term infants from both normal deliveries (NORM, n=29) and nuchal cords (NUCH, n=33). BG/pH and hematocrit were measured; base deficits and oxygen contents were calculated; and a member of the study assigned Apgar scores and demographic data were collected from the babies' charts. RESULTS: Median Apgar scores in the NUCH babies at 1 and 5 minutes were 9 and 9 respectively, which did not differ from the NORM infants. The pH, PCO(2), and oxygen content obtained from UV of the NUCH infants was not statistically different from the NORM. The pH and oxygen content of the NUCH UA was significantly lower than that of the NORM. The UA PCO(2) in the NUCH was greater than the NORM. Veno-arterial (VA) differences (Delta VA) in pH and PCO(2) of the NUCH infants were greater than that of the NORM. CONCLUSION: The Apgar score is not a sensitive indicator of acid-base changes in nuchal cord patients; UV samples alone may be misleading. UA must be sampled to detect the hypercapnia and diminished oxygen content that is a result of the nuchal cord.
Apgar fuzzy expert system (AFES) applied fuzzy logic to the Apgar Scoring System (APG). We prepared the AFESs for both an inexperienced obstetrician (resident A) and an experienced obstetrician (specialist B) separately. We then compared their evaluations of the same 80 neonates at 1 min after birth using both the AFES and the APG. Analysis of the relationship of the general evaluation by the APG (scores below 6 or over 7) and the AFES (bad or good) to the umbilical arterial blood gases (pH below or above 7.20) showed that the sensitivities were 0.36 for the APG evaluation by resident A, 0.50 for the APG evaluation by specialist B, 0.60 for the AFES rating by resident A, and 0.71 for the AFES rating by specialist B. The specificities were 0.94, 0.95, 0.97 and 0.97, respectively. These results demonstrated that the AFES was capable of reflecting the recognition of the examiner.
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A 28-year-old woman admitted to the emergency department with a Glascow Coma Scale score of 4 after a closed head injury resulting from a motor vehicle crash was found to have a positive serum beta-human chorionic gonadotropin level of 27 mIU/mL. After stabilization and treatment for her closed head injury, she remained in a comatose state for more than 240 days. At 36 to 37 weeks' gestation, she had contractions and elevations in her blood pressure. A healthy female infant was born by an operative vaginal delivery with Apgar scores of 9 and 9.
The Apgar score has been useful for nearly four decades in focusing on five physiological signs (heart rate, respiratory effort, reflex irritability, muscle tone, color) that denote the condition of an infant during the first critical minutes of life. Before the development of the system, narcotic analgesia and sedation during labor, and general anesthesia for vaginal deliveries were commonly used. Research of the scoring method has focused on the effects of these interventions on the fetus and newborn and has been a major impetus for change in obstetric practices. The Apgar score has been used as a predictive index for neonatal mortality and morbidity and for later neurologic or developmental disability. Both the one- and five-minute scores are predictors of mortality in normal-birthweight infants, whereas in high-risk low-birthweight infants their score is limited. The score is an insensitive predictive index of long-term neurologic or mental handicap, and lacks both sensitivity and specificity to reflect accurately the degree of acidosis. It can be used effectively, however, if these limitations are understood and considered.
OBJECTIVE: To compare the predictive accuracy of the NEOMOD score and the Apgar score as concerns prediction of mortality and affection of the central nervous system (CNS) in neonates. DESIGN: Prospective multi-centre clinical study. SETTING: Mother and Child Care Institute, Prague; Thomayer's Faculty Hospital with a Policlinic, Prague. METHODS: All neonates with a gestation age > or =35 weeks of pregnancy, hospitalised in the intensive care units of the cooperating hospitals in the period 1998-2002, were included in the study. For all the neonates, the NEOMOD score was established in the first 24 hours and the Apgar score was established in the 1st, 5th and 10th minutes of their lives. The aim was to establish the predictive accuracy of the scoring systems for mortality and affection of CNS in the first 28 days of life. RESULTS: 620 patients participated in the study; 16 patients (1.90%) died by the 28h day. The predictive accuracy for mortality expressed as AUS - the area under receiver operating characteristic (ROC) curve reached the highest level for NEOMOD AUC = 0.96. AUC for the Apgar score was 0.84 in the 1st minute; it was 0.84 in the 5th minute and it was 0.88 in the 10th minute. The predictive accuracy for affection of CNS was AUC = 0.76 in the case of NEOMOD; in the case of Apgar, AUC was 0.71, 0.74 and 0.77 in the 1st, 5th and 10th minute, respectively. CONCLUSION: The NEOMOD system proved a high accuracy in the prediction of neonatal mortality in a group of patients with a gestation age > or =35 weeks of pregnancy. The predictive accuracy of NEOMOD was higher than that of the Apgar score. The predictive accuracy of both the NEOMOD and Apgar scores for affection of CNS in the neonatal period was low.
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The association between Apgar score, pH and catecholamine levels was investigated in 181 newborn infants with a gestational age between 29 and 43 completed weeks. Umbilical arterial blood was obtained before the first breath with the double clamp technique and pH was measured. Plasma adrenaline and noradrenaline were analyzed by high performance liquid chromatography. The Apgar score at 1 minute was above or equal to seven in 167 infants. Forty-four per cent of these infants had pH below 7.25. A negative correlation between log noradrenaline and pH (r = 0.52, p less than 0.001) and between log adrenaline and pH (r = 0.40, p less than 0.001) was found. In 14 infants the Apgar score was below seven. The median pH was 7.21 (range 7.02-7.32). Also in this group a negative correlation between log noradrenaline and pH (r = 0.60, p less than 0.05) and between log adrenaline and pH (r = 0.77, p less than 0.01) was noted. We concluded that the Apgar score is an insufficient measure of fetal asphyxia defined as fetal acidosis but rather reflects the vitality of the newborn.
The Apgar score is widely used for several purposes: to discriminate between infants who require resuscitation at birth and those who do not; to predict outcome; and to evaluate change in the condition of the newly born over the first minutes of life. Using published evidence of its clinical reliability and validity, this article explores whether the Apgar score serves all three measurement purposes equally well. Methodologic guidelines for assessing health indices are applied to examine the structure of the Apgar score as well as its function where performance data are lacking or inadequate. Despite the advent of modern technology, the Apgar score remains the best tool for the identification of newly born infants in need for cardiopulmonary resuscitation. For predicting later death or handicap, the Apgar score is insensitive but fairly specific. The ability of the Apgar score to measure change over time has not been studied systematically; however, available data suggest that serial Apgar ratings in infants with early low scores detect clinically important recovery of lack thereof.
Infants with 0-3 Apgar scores at 1 minute had significantly lower 8-month mental and motor scores than infants with 7-10 scores and significantly lower mental but not motor scores than infants with 4-6 Apgar scores. Correlations indicated significant relationships (independent of birth weight) between Apgar scores and Bayley mental and motor scores for random, Colored Portuguese, and total samples but not for Negroes and whites. Results demonstrated a significant difference in Apgar scores by 8-month classifications with significantly lower scores for children classified as abnormal, and by longevity with significantly lower scores for neonates who died within 2 days.
Apgar score remains permanent conquest of medicine due its objective evaluation of available point counting of the level and quickness of newborn's breathing-circulation system adaptation to the new environment. For its example the score of fetal and newborn's maturation evaluation has been described. The matter is in this so that Apgar score don't be using for evaluation of fetal maturity because it is easy to determine it directly. Of course, the higher fetal maturity level the higher probability of high Apgar score, and the quicker and better post-partum child's adaptation for independent life in new circumstances takes place.