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Audrius

Apgar score for normal birth?

are healthy babies evalueted by Apgar score in your facilities?  

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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.

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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

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Guest SAEED ABDELAATY MABROUK

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.

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Guest drhassan.nimer@gmail.com

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/

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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

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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.

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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 ,,,,

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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.

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