Niemuth Mara, Küster Helmut, Simma Burkhard, Rozycki Henry, Rüdiger Mario, Solevåg Anne Lee
Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Clinic for Pediatric Cardiology, Intensive Care and Neonatology, University Medical Center Göttingen, Göttingen, Germany.
Pediatr Res. 2024 Aug;96(3):625-631. doi: 10.1038/s41390-021-01896-7. Epub 2021 Dec 30.
Assessment of an infant's condition in the delivery room represents a prerequisite to adequately initiate medical support. In her seminal paper, Virginia Apgar described five parameters to be used for such an assessment. However, since that time maternal and neonatal care has changed; interventions were improved and infants are even more premature. Nevertheless, the Apgar score is assigned to infants worldwide but there are concerns about low interobserver reliability, especially in preterm infants. Also, resuscitative interventions may preclude the interpretation of the score, which is of concern when used as an outcome parameter in delivery room intervention studies. Within the context of these changes, we performed a critical appraisal on how to assess postnatal condition of the newborn including the clinical parameters of the Apgar score, as well as selected additional parameters and a proposed new scoring system. The development of a new scoring system that guide clinicians in assessing infants and help to decide how to support postnatal adaptation is discussed. IMPACT: This critical paper discusses the reliability of the Apgar score, as well as additional parameters, in order to improve assessment of a newborn's postnatal condition. A revised neonatal scoring system should account for infant maturity and the interventions administered. Delivery room assessment should be directed toward determining how much medical support is needed and how the infant responds to these interventions.
在产房对婴儿状况进行评估是充分启动医疗支持的前提条件。弗吉尼亚·阿普加在其具有开创性的论文中描述了用于此类评估的五个参数。然而，自那时以来，孕产妇和新生儿护理已经发生了变化；干预措施得到了改进，婴儿甚至更加早产。尽管如此，阿普加评分仍在全球范围内用于婴儿，但人们担心观察者间的可靠性较低，尤其是在早产儿中。此外，复苏干预可能会妨碍对该评分的解读，这在产房干预研究中将其用作结果参数时令人担忧。在这些变化的背景下，我们对如何评估新生儿出生后的状况进行了批判性评估，包括阿普加评分的临床参数，以及选定的其他参数和一个提议的新评分系统。本文讨论了一种新评分系统的开发，该系统可指导临床医生评估婴儿，并有助于决定如何支持出生后的适应过程。影响：这篇批判性论文讨论了阿普加评分以及其他参数的可靠性，以改善对新生儿出生后状况的评估。修订后的新生儿评分系统应考虑婴儿的成熟度和所实施的干预措施。产房评估应旨在确定需要多少医疗支持以及婴儿对这些干预措施的反应如何。
