Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes

• Published in: PloS one Vol. 11; no. 2; p. e0149464
• Main Authors: Dalili, Hosein, Sheikh, Mahdi, Hardani, Amir Kamal, Nili, Firouzeh, Shariat, Mamak, Nayeri, Fatemeh
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12-02-2016; Public Library of Science (PLoS)
• Subjects: Age; Apgar Score; Area Under Curve; Biology and Life Sciences; Birth Weight; Breastfeeding & lactation; Care and treatment; Committees; Diagnosis; Female; Gestational Age; Gynecology; Health risk assessment; Health screening; Hemorrhage; Humans; Hyperbilirubinemia; Infant; Infant Mortality; Infant, Newborn; Mechanical ventilation; Medicine and Health Sciences; Methods; Morbidity; Mortality; Neonatal diseases; Neonates; Newborn babies; Pediatrics; People and Places; Predictions; Prospective Studies; Respiration, Artificial; Resuscitation; Risk factors; ROC Curve; Subgroups; Ventilation; Iran
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0149464

Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar.
This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality.
Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75-51.29), IVH (OR,4.8; 95%CI,1.91-12.01), and neonatal mortality (OR,20.22; 95%CI,4.22-96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups.
The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates.