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Hi,

 

we had a (more academically) discussion about APGAR scoring. I would like to hear your opinion about scoring breathing effort:

 

A fullterm infant breathing spontaneously but needing CPAP via a T-piece device.

Would you score it as APGAR 1 or 2?

Would the need of extra oxygen affect your decision?

 

Greetings

Dirk

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I have always thought that the original idea of the Apgar score was a neurological assessment - and have therefore graded breathing depending on regularity of the breathing drive: 0= no breaths, 1=some/irregular breathing, 2=regular breathing (regardless of effort/O2)

 

Another area of confusion and debate is the score for color, almost worth a topic on its own :)

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Apgar scoring was developed before the era of care for VLBW/ELBW newborns. Despite occasional reinterpretations of how to score, practically, we can try to maintain the original intest of the assessment. I would score "1" in the instance you mention. Respirations are present but not normal. By the way, Apgar is an eponym (for Virginia Apgar) not an acronym (APGAR). I have been told by many trainees over the years what A, P, G, A & R stand for (unfortunately).

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Hi,

 

we had a (more academically) discussion about APGAR scoring. I would like to hear your opinion about scoring breathing effort:

 

A fullterm infant breathing spontaneously but needing CPAP via a T-piece device.

Would you score it as APGAR 1 or 2?

Would the need of extra oxygen affect your decision?

 

Greetings

Dirk

 

APGAR scoring : reasons for low objectivity :

 

 

Score during intervention:  Skin color (respiratory support or O2 administration) 

                                                Respiration (CPAP or surfactant)

                                                Heart rate (respiratory support or drugs)

 

score in preterm infant:       muscle tone

                                                reflex state

 

So there is a need to assess condition of newborn regardless of GA or intervention 

 

this is done by using COMBINED APGAR description of baby condition:

 

 

C: CPAP                                                              A: Appearance         

O : oxygen supplements                                  P: pulse

M&B: Mask and Bag ventilation                     G: grimace

I: intubation                                                       A: Activity

N: neonatal chest compression                      R: respiration

E: Exogenous surfactant

D: Drugs

 

NO= 1 / yes=0                                                    Best= 10   worse = 0

No intervention 7 / all intervention 0

 

Optimum of 17 point …….worse of 0 point

Dr.Waad E. Louis

Baghdad / Iraq

wowmeew@gmail.com

+9647702955370

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Hi, I'm in agreement with Irubin. Apgar score was designed for all newborns including preemies. But in the times of V.Apgar preemies were more than 30 Hbd, and 30 HBD was considered extremely immature. But the discussion is about term newborn. If child's spontaneous breath is not sufficient eg. baby doesn't cry loudly or breathing regulary - it means not quite good quality of breathing. So the easiest approach: Baby doesn't need my help - 2 points, needs any help (including oxygen, but we don't start with oxygen in term newborn i Europe -ERC 2010) - 1 point, needs ventilation including 5 initial breaths and after it still needs ventilation on the end of 1 minute after birth - 0 points. 

But as I know there are neonatal units using quite different approach.

Best for all, have a good day

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Hello and many thanks for you answers!

 

Going on with this discussion I have gone back to the roots: Virgina Apgar wrote in her article 1953

"A Proposal for a New Method of Evaluation of the Newborn Infant":

 

(2) Respiratory Effort. -- An infant who was apneic at 60 seconds after birth received a score of zero,

while one who breathed and cried lustily received a two rating. All other types of respiratory effort,

such as irregular, shallow ventilation were scored one.  

 

Greetings Dirk    

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Guest marcydf

Just my opinion to your question:

The baby is pink? 2.

I don't think that it's important how to obtain the score: if I need epinephrine to have a HR >100 bpm, the score for HR will be 2. Doesn't matter if i need the drug. The same for colour: if I need O2 to have a pink baby, the score for colour will be 2. Again: I need to intubate the infant: if the newborn is apneic and i need to ventilate, score will be 0, but if the baby is crying (i can't hear the cry, but i can SEE it) the score will be 2 etc etc

Sometimes I have to  explain to postgraduates that they must assist at birth a baby for his/her needs (just drying / gentle stimulation / hard resuscitation) and then apply a score (the Apgar score) to evaluate the result of care. This is the reason that doesn't exists a 5 seconds Apgar score.

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