Posted January 18, 201411 yr 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
January 19, 201411 yr Gestational age may be a factor (i.e. 25 weeks with CPAP vs. term) - more than likely I would still give 2 points if spontaneously breathing consistently.
January 19, 201411 yr 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
January 19, 201411 yr 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).
January 20, 201411 yr 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
January 21, 201411 yr 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
January 21, 201411 yr Author 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
January 21, 201411 yr Going on with this discussion I have gone back to the roots: @wackdi - I was reading exactly this too just before lunch today! (and then titus came and we had lunch)
January 23, 201411 yr We all have confusion over how best thar Apgar scoring is done, still all of us agreeing to continue to use in our clinical practice!!! Dr Apgar must be feeling happy up there!!
January 30, 201411 yr 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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