Dear coleagues,

I believe that most of you were in the delivery room and more than one time in your practise. If the baby did not required resuscitation, was he/she rated by Apgar score?

The question is: are healthy babies evalueted by Apgar score in your facilities?

Thank you for responses,

Audrius

Yes

Well, it's nice, You ansvered fot Your question Is it a provocation or something:)

Pozdrowienia:)

I think Adrius question was meant like a poll/survey.

So, a poll has been added now, please submit your reply there and add any comments below!

BTW, almost all infants born in Sweden have Apgar scores recorded.

Midwifes set the scores in all infants who do not need any interventions by a pediatrician/neonatologist. Otherwise the ped/neo-dr set the scores.

We use Apgar scores for every newborn, even for premature. It's not a ideal score, but for now, it's the best we have". For parents it's the best indicator of condition of their child.

in Scotland we also use the Apgar score for all newborns, if all is well in the delivery room, again the midwife determines the score. Not the best tool, often determined in hindsight, but yes, its all we have too!

In my centre-Danang Vietnam, we use Apgrar score for all newborn but for resucitation, we are using the flow chart of Neonatal resuscitation from AAP and AHH

We also use Apgar score in all our infants. But we have a problem with scoring the preemies who need resuscitation immediately after birth. When you intubate in the first minute of life - does it make sense to you to score for instance for "breathing" ? If yes - it sounds impossible, because you ventilate the baby.... if not - you have very low scores and that suggest prolonged asphyxia... for example - 4 in the fifth minute. ( 2 only for heart rate and colour, but 0 for breathing, tension and reaction for catheter...) What is your experience/opinion?

I am a nurse. I have always seen Apgar scores done. If, @ 1 minute, the baby is intubated and being bagged, I would probably score 0, then evaluate for the other criteria. If the Apgar @ 5 minutes was < 6, I would repeat the scoring @ 10 mins.

I've also seen Apgars given by Delivery Room RNs, ALS RNs (in our Level 2 nursery, RNs are trained to resuscitate, intubate, place umbilical lines, etc., until the Neonatalogist and/or transport team arrive). In my previous job, a Level 3 Unit, the residents and fellows gave the score @ the deliveries they attended, otherwise, the Delivery room nurse did it.

Many thanks for replays. Another question: do you think that is reasonable to assess healthy babies by Apgar score? 1.Yes, 2.No, 3.I see no point in this question.

Dear Adrius, it is not possible to re-start the poll with different alternatives, you would need to start a new thread (by the way, you can add a poll yourself too, when starting a new thread!)

But I suggest we continue the discussion about your second question below.

I think Apgar scores are a quite crude marker of the condition of the infant at birth, but it gives some basic information about the unwell newborn infant. By using it on every child, midwifes and doctors do Apgar scoring "by automatic", also in cases where Apgar scores have some value. But I think you Adrius have a point, scoring the 9-10-10 infants may not be reasonable for its own sake!

Dear Stefan,

Thanks for your replay. The idea of the question was: if people score all the newborns "automatic" or routine, they simply forgets the real signs of Apgar score (this is my experience from many countries wich I have visited). So, my proposal would be to stop scoring healthy babies who don't require any extra help after birth.

Audrius

The idea of the question was: if people score all the newborns "automatic" or routine, they simply forgets the real signs of Apgar score (this is my experience from many countries wich I have visited). So, my proposal would be to stop scoring healthy babies who don't require any extra help after birth.

I cannot do anything but agree. One should do a study about the reliability of Apgar scoring in healthy term infants. It is quite likely that the 9-10-10-scores for well infants have problems with both sensitivity and specificity (says the perinatal epidemiologist in me). If someone put this idea into practise, please acknowledge 99nicu in the article

Dear Colleague, dr Stefan

I think that no doubt that Apgar Scor should be considered and done in ill or healthy babies, why? this is a beginning of the history of the newborn, that shows signs,symptoms, behaviours and other systemic conditions exactly at birth. Without Apgar the physician may mistake or forget some unseen signs. Thank you

dr Hasan N Qasim

pediatrician

all we are going to talk about one word "apgar" and it means so many things between us.it is important to use one system.

so if we used to record "male/ female" or "gestational age" etc , it is the same to me.

well baby for who ? there are so many different education types in Türkiye also )

have a nice weekend.

I think that the apgar score was usefull in his moment, but today we evaluate every newborn baby more especifically because we use the neonatal reanimation program. The Apgar Score sometimes do not denote anything for example in a mother with anesthesia effects. I think in the future we have to make a differente score which really evaluates the hemodinamically condition of a baby and his neurologic outcome. Remember that the great % of babies with cerebral palsy had normal apgar score.

thanks.

What is the neonatl reanimation program ?

We use Apgar scores for every newborn, even for premature. It's not a ideal score, but for now, it's the best we have". It is done by the obstetricians & Pediatricians in our place not the midwives.

Dr. Prasad Rao

Pediatrician & Neonatologist

Hyderabad

India

Anyone have any info on the "Expanded APGAR?"

Hi

Every baby whether needed resuscitation or not awarded an Apgar score at 1minute and 5 minute and that i think is standard of practice according to NRP guidelines.

Even if there is no Neonatologist or Pediatrician in the Operating room/L&D suites Apgar score is awarded to the baby by Resuscitation Nurse.

Anyone have any info on the "Expanded APGAR?"

What do you mean by "Expanded Apgar"?

Revised scoring system?

BW, Stefan

Dear Colleague, Apgar score is necessary to be recorded for every NB at first and fifth minute.

We also use Apgar score in all our infants. But we have a problem with scoring the preemies who need resuscitation immediately after birth. When you intubate in the first minute of life - does it make sense to you to score for instance for "breathing" ? If yes - it sounds impossible, because you ventilate the baby.... if not - you have very low scores and that suggest prolonged asphyxia... for example - 4 in the fifth minute. ( 2 only for heart rate and colour, but 0 for breathing, tension and reaction for catheter...) What is your experience/opinion?

Apgar scores still apply as per usual but specific mention should be made about resuscitation and at what point in time baby was intubated and ventilated. pdmuller

Hi all,

Nice thread that has been introduced there.

In our practice,we use to score all newborns (midwives or neonatologists). I would like to remind you that when first described by V. Apgar, the score was created for grading newborns and used as a basis for discussion and comparison of the obstetric practices at that time...But, years ago, we are facing a "wrong" use of it; I mean as a marker for later outcomes. Experts have demonstrated that Apgar score is a useful tool for predicting 28day mortality but not risks of disabilities. I agree with Manuel;we have to look for more accurate scores to evaluate our newborns and I think that the SNAP-PE is one of those since it has been stated that it well correlates with MRS results in predicting neurologic outcome.

Hope this help continuing such a research.

is ther any better system of scoring than apgar score in term of longterm outcome

I have worked in Australia, United Kingdom, Saudi Arabia and India with many health professionals from many different counties. When you state Apgars it is understood. It is the universal language for neonatal resuscitation. Yes it is subjective, but differences of opinion are usually only marginal. If you have Apgars of 3 or 4 at one /five or 10 minutes, you have an immediate idea of what has happened.

As far as giving IPPV, what do you score? I would suggest if you are adequately ventilating then you give a score but you identify clearly on the Apgar chart the baby was recieving IPPV.

...Apgars... It is the universal language for neonatal resuscitation...

That sentence will become a classic!

And I agree, too.

Policy Statement from the American Academy of Pediatrics reprinted in "Advances in Neonatal Care", Volume 6, Number 4 (August), 2006: pp220-223:

"Abstract: The Apgar score provedes 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 of the term infant. There are no consistent date 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."

Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists propose use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.

The article in "Advances in Neonatal Care" has a diagram of what the proposed Expanded Apgar score form looks like. I attempted to demonstrate it in this forum but because of the size of the forum pages it did not come out correctly. I very highly recommend you look for the form as seen in either the "Pediatrics" or "Advances in Neonatal Care" journals. I think it is a wonderful idea to help demonstrate what was happening during the delivery of premature babies and babies who require resuscitation at delivery.

"Figure 1. Expanded Apgar score form. Record the score in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported using a check mark inthe appropriate box. Use the comment box to list other factors including maternal medications and/or the response to resuscitation between the recorded times of scoring. PPV/NCPAP indicates positive-pressure ventilation/nasal continuous positive airway pressure; ETT, endotracheal tube."

In general the Apgar score form looks like it always did and is printed on the left side of the page. At the top right is "Gestational Age_______ weeks". To the right of the form there are 5 boxes under the headings of 1, 5, 10, 15, and 20 minute intervals for recoreding of more apgar scores as a resuscitation progresses. Beneath this is a second area of which the left side is an empty box with the word "Comments" in it. To the right of the box is the title "Resuscitation" and under it is a table with the times of 1,5,10,15 and 20 minute intervals which a placed immediately under the Apgar table above it. To the left of the table each line has a specific word: oxygen, PPV/NCPAP, ETT, Chest compressions, Epinephrine. I will try to demonstrate that below.

.......................................Resuscitation

_____________________________________________

Minutes.......................1.....5......10......15......20

_____________________________________________

Oxygen

_____________________________________________

PPV/NCPAP

_____________________________________________

ETT

_____________________________________________

Chest Compressions

_____________________________________________

Epinephrine

_____________________________________________

I hope this is helpful.

A.M.,RNC

Level III NICU Staff Nurse

Southeastern USA

I admire you to open this point . Of course, A.S. is the best we have so far specially medicolegal. yet let's agree together to write :GOOD for A.S. of 7 or more at 1 min. and if it's 6 or less write it as usual at 1 & 5 min. and if it's 6 or less at 5 min.,we've to expand its score at 15&20 min.

Dear Colleague, Apgar Score should be done for every Newborn infant.The medical condition of the newborn at the time of birth also must be registered either by Pediatrician/Nutrition or Midwife, any way this is better oespecially if it is done for over 20 minutes interval. Thanks for all

dr Hasan / pediatrician/

Dear all

Can I ask you is it valuable to say apgar score of >3 at minutes of age can be highly dependable to say the baby will not be at risk of perinatal depression complication and outcomes and in the other hand were all those who had apgar score < 3 at 5 minute of age definitly will be symptomatic at birth or shortly later.

thanks.

Dr. kareem

Check this out in NEJM; about the apgar score in the "21st century"

Article: The Continuing Value of the Apgar Score for the Assessment of Newborn Infants

Commentary: The Apgar Score in the 21st Century

My personal opinion is that Apgar score is should be considered as one of many factors in attempts to predict outcomes. Need of resuscitation, umbilical blood gases and other lab tests, the degree of encefalopathy, aEEG (CFM), etc-etc all add to the picture.

why to put apgar score if the baby is healthy and needs no level of resucitation (exclude research),,do you change a flat tire if it is not flat ,,,,

I believe it is all about documentation. Naturally we could just write down "all was ok at resuscitation", but due to the universal usage of the apgar score - the meaning of 3 simple numbers tells me alot more about what the child was like in the first minutes of life.