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AAP, ACOG recommend improved use of Apgar score
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A joint policy statement issued today by the AAP and the American College of Obstetricians and Gynecologists recommends improvements for and defines appropriate use of the Apgar score.
The statement — in which the organizations emphasized the importance and convenience of the Apgar score for determining the status of neonates immediately after birth— is intended to put use of the Apgar score into its proper context.
Kristi L. Watterberg
“The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if it is needed; however, it has been inappropriately used to predict individual adverse neurologic outcome,” chairwoman Kristi L. Watterberg, MD, FAAP, of the AAP committee on fetus and newborn, and colleagues wrote.
The Apgar score determines the clinical status of newborns at 1 minute of age and the need for treatment to establish breathing. The score assesses the infant’s color, heart rate, reflexes, muscle tone and respiration. Each attribute is assigned a score (0-2), and the scores at 1 minute and 5 minutes are combined for a total score. After that, further testing is done for infants who score lower than 7.
The committee wrote that while the Apgar score is useful for determining the overall status of an infant and the response to resuscitation efforts, it should not be used as a determinant of the need for resuscitation.
“Resuscitation must be initiated before the 1-minute score is assigned. Therefore, the Apgar score is not used to determine the need for initial resuscitation, what resuscitation steps are necessary, or when to use them,” they wrote.
The primary recommendation issued in the AAP/ACOG policy statement states that the Apgar score should not be used as a predictor of individual neonatal mortality or neurological outcomes.
“The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity,” Watterberg and colleagues wrote. “A 5-minute Apgar score of 0 to 3 correlates with neonatal mortality in large populations but does not predict individual future neurologic dysfunction.”
Other recommendations include:
- prohibiting use of the Apgar score alone to establish the diagnosis of asphyxia;
- retrieval of umbilical artery blood gas from a clamped portion of the umbilical cord, in the event that an infant has an Apgar score of 5 or less at 5 minutes of age;
- submitting the placenta of newborns with a score of 5 or less at 5 minutes of age for pathological examination;
- consistency in assigning Apgar scores during all resuscitative interventions; and
- use of an expanded Apgar score reporting form that documents all concurrent resuscitative interventions.
“The Apgar score describes the condition of the newborn infant immediately after birth and, when properly applied, is a tool for standardized assessment,” Watterberg and colleagues wrote. “It also provides a mechanism to record fetal-to-neonatal transition. Apgar scores do not predict individual mortality or adverse neurologic outcome.”
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