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    AAP recommends Apgar score expansion

     

    However, the statement notes that Apgar scores of 0 beyond 10 minutes of age may be useful in determining whether continued resuscitation efforts should be indicated, since AAP and ACOG say few infants with those scores survive such lengthy resuscitation with normal neurologic outcomes.

    The 2014 Neonatal Encephalopathy and Neurologic Outcome report defines
a 5-minute Apgar score of 7 to 10 as “reassuring;” a score of 4 to 6 as “moderately abnormal;” and a score of 0 to 3 as “low” or possibly indicative of non-specific illness or possible encephalopathy in term and late preterm infants.

    The revised statement also clarifies that, despite findings of distress in infants with low Apgar scores, the scoring is not a specific indicator for poor outcomes and has lead to “an erroneous definition of asphyxia.”

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    “The Apgar score by itself does not equal 'asphyxia,’” Kristi Watterberg, MD, professor of pediatrics and neonatology at the University of New Mexico School of Medicine and one of the report authors says.

    “Asphyxia is defined as the marked impairment of gas exchange, which, if prolonged, leads to progressive hypoxemia, hypercapnia, and significant metabolic acidosis. The term asphyxia, which describes
a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be documented on the basis of laboratory test results,” the report notes.

    The revised statement also notes that, despite its benefits, the Apgar has drawback in that it is a subjective assessment of an infant’s physiologic condition at 1 specific point in time. Many factors can affect the score, including maternal sedation, interobserver variability, trauma, and more—but biochemical disturbances must be profound to affect the score. Apgar scoring may also be affected by variations in normal fetal to infant transition. The AAP and ACOG give the example of infants with initial low oxygen saturations that do not require supplemental oxygen—the Neonatal Resuscitation Program targets for oxygen saturation are 60% to 65% at 1 minute and 80% to 85% by 5 minutes.

    “The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity,” according to the statement. “The incidence of low Apgar scores is inversely related to birth weight, and a low score cannot predict morbidity or mortality for any individual infant … it is also inappropriate to use an Apgar score alone to diagnose asphyxia.”

    NEXT: How has the reporting form changed?

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...

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