Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes

Hosein Dalili, Firouzeh Nili, Mahdi Sheikh, Amir Kamal Hardani, Mamak Shariat, Fatemeh Nayeri, Hosein Dalili, Firouzeh Nili, Mahdi Sheikh, Amir Kamal Hardani, Mamak Shariat, Fatemeh Nayeri

Abstract

Objectives: To compare the Conventional, Specified, Expanded and Combined Apgar scoring systems in predicting birth asphyxia and the adverse early neurologic outcomes.

Methods: This prospective cohort study was conducted on 464 admitted neonates. In the delivery room, after delivery the umbilical cord was double clamped and a blood samples was obtained from the umbilical artery for blood gas analysis, meanwhile on the 1- , 5- and 10- minutes Conventional, Specified, Expanded, and Combined Apgar scores were recorded. Then the neonates were followed and intracranial ultrasound imaging was performed, and the following information were recorded: the occurrence of birth asphyxia, hypoxic Ischemic Encephalopathy (HIE), intraventricular hemorrhage (IVH), and neonatal seizure.

Results: The Combined-Apgar score had the highest sensitivity (97%) and specificity (99%) in predicting birth asphyxia, followed by the Specified-Apgar score that was also highly sensitive (95%) and specific (97%). The Expanded-Apgar score was highly specific (95%) but not sensitive (67%) and the Conventional-Apgar score had the lowest sensitivity (81%) and low specificity (81%) in predicting birth asphyxia. When adjusted for gestational age, only the low 5-minute Combined-Apgar score was independently associated with the occurrence of HIE (B = 1.61, P = 0.02) and IVH (B = 2.8, P = 0.01).

Conclusions: The newly proposed Combined-Apgar score is highly sensitive and specific in predicting birth asphyxia and also is a good predictor of the occurrence of HIE and IVH in asphyxiated neonates.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. The Combined-Apgar scoring system, consists…
Fig 1. The Combined-Apgar scoring system, consists of the Expanded and Specified Apgar scoring systems.
In 2012 the Combined-Apgar score was introduced by Rudiger et al.
Fig 2. ROC curve showing the sensitivity…
Fig 2. ROC curve showing the sensitivity and Specificity of Conventional, Specified, Expanded and Combined Apgar scores in predicting birth asphyxia.

References

    1. Umbilical cord blood gas and acid-base analysis. ACOG Committee Opinion No. 348. American College of Obstetricians and Gynecologists. Obstet Gynecol 2006;108:1319–22.
    1. Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatr. 1995;84:927–32.
    1. Whitelaw A, Thoresen M. Clinical trials of treatments after perinatal asphyxia. Curr Opin Pediatr. 2002;14:664–8.
    1. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32:260–267
    1. Misra PK, Srivastava N, Malik GK, Kapoor RK, Srivastava KL, Rastogi S. Outcome in relation to Apgar score in term neonates. Indian Pediatr. 1994;31:1215–8.
    1. Ondoa-Onama C, Tumwine JK. Immediate outcome of babies with low Apgar score in Mulago Hospital, Uganda. East Afr Med J. 2003;80:22–9.
    1. Padayachee N, Ballot DE. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. South African Journal of Child Health. 2013;7: 89–94
    1. The Apgar score. ACOG Committee Opinion No. 333. American Academy of Pediatrics; American College of Obstetricians and Gynecologists. Obstet Gynecol 2006;107:1209–12.
    1. Lopriore E, van Burk GF, Walther FJ, de Beaufort AJ. Correct use of the Apgar score for resuscitated and intubated newborn babies: questionnaire study. BMJ. 2004;329:143–4.
    1. Rüdiger M, Wauer RR, Schmidt K, Küster H. The Apgar score. [Letter to the Editor] Pediatrics. 2006;118:1314–1315.
    1. Rüdiger M, Braun N, Gurth H, Bergert R, Dinger J. Preterm resuscitation I: clinical approaches to improve management in delivery room. Early Hum Dev. 2011;87:749–53. 10.1016/j.earlhumdev.2011.08.019
    1. Rüdiger M, Aguar M. Newborn Assessment in the Delivery Room. Neoreviews 2012;13;e336 10.1097/PCC.0b013e318253c945
    1. Rüdiger M, Kuster H, Herting E, Berger A, Müller C, Urlesberger B, et al. Variations of Apgar score of very low birth weight infants in different neonatal intensive care units. Acta Paediatr. 2009;98:1433–6. 10.1111/j.1651-2227.2009.01347.x
    1. Fahey J, King TL. Intrauterine asphyxia: clinical implications for providers of intrapartum care. J Midwifery Womens Health. 2005;50:498–506.
    1. Martin-Ancel A, Garcia-Alix A, Gaya F, Cabanas F, Burgueros M, Quero J. Multiple organ involvement in perinatal asphyxia. The Journal of pediatrics. 1995;127:786–93.
    1. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976; 33:696–705.
    1. Sykes GS, Molloy PM, Johnson P, Gu W, Ashworth F, Stirrat GM, et al. Do Apgar scores indicate asphyxia? Lancet. 1982;1:494–6.
    1. Is the Apgar score outmoded? Lancet. 1989;1(8638):591–92.
    1. Marlow N. Do we need an Apgar score? Arch Dis Child. 1992;67:765–7.
    1. Behnke M, Eyler FD, Carter RL, Hardt NS, Cruz AC, Resnick MB. Predictive value of Apgar scores for developmental outcome in premature infants. Am J Perinatol. 1989;6:18–21.
    1. Socol ML, Garcia PM, Riter S. Depressed Apgar scores, acid-base status, and neurologic outcome. Am J Obstet Gynecol. 1994;170:991–8; discussion 8–9.

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