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PLoS One. 2016 Feb 12;11(2):e0149464. doi: 10.1371/journal.pone.0149464. eCollection 2016.

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

Author information

1
Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2
Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

OBJECTIVES:

Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
26871908
PMCID:
PMC4752486
DOI:
10.1371/journal.pone.0149464
[Indexed for MEDLINE]
Free PMC Article

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