Rüdiger Mario, Braun Nicole, Aranda Jacob, Aguar Marta, Bergert Renate, Bystricka Alica, Dimitriou Gabriel, El-Atawi Khaled, Ifflaender Sascha, Jung Philipp, Matasova Katarina, Ojinaga Violeta, Petruskeviciene Zita, Roll Claudia, Schwindt Jens, Simma Burkhard, Staal Nanette, Valencia Gloria, Vasconcellos Maria Gabriela, Veinla Maie, Vento Máximo, Weber Benedikt, Wendt Anke, Yigit Sule, Zotter Heinz, Küster Helmut
Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
BMC Pediatr. 2015 Mar 8;15:18. doi: 10.1186/s12887-015-0334-7.
Since an objective description is essential to determine infant's postnatal condition and efficacy of interventions, two scores were suggested in the past but weren't tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.
Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.
Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.
The Combined-Apgar allows a more appropriate description of infant's condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.
clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.
由于客观描述对于确定婴儿出生后的状况及干预效果至关重要，过去曾提出两种评分方法，但尚未进行测试：特定阿氏评分使用传统阿氏评分的5项指标；然而，该评分方法描述的状况不考虑胎龄（GA）或复苏干预措施。扩展阿氏评分衡量达到该状况所需的干预措施。我们假设两者结合（联合阿氏评分）比单独使用任何一种评分方法能更好地描述早产儿出生后的状况。
对妊娠32周以下的早产儿进行评分评估。在12个国家的20个新生儿重症监护病房前瞻性收集数据。将不良结局（死亡、重度/中度支气管肺发育不良、脑室内出血、脑室周围白质软化和视网膜病变）的预测作为比较评分的替代参数。为比较预测价值，计算ROC曲线下面积（AUC）。
在2150例符合条件的新生儿中，分析了1855例平均胎龄为28（6/7）±2（3/7）周的婴儿的数据。在1分钟时，联合阿氏评分在预测不良结局方面明显优于单独的特定阿氏评分或扩展阿氏评分。在5分钟或10分钟时得分极低的婴儿中，分别有81%或100%的婴儿有不良结局。在这些婴儿中，围产期死亡率的相对风险分别为24.93（13.16 - 47.20）和31.34（15.91 - 61.71）。
联合阿氏评分能在现代新生儿护理条件下更恰当地描述婴儿状况。它应用作更好地比较婴儿组和出生后干预措施的工具。
clinicaltrials.gov协议注册系统（NCT00623038）。2008年2月14日注册。
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