ReviewA review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings
Introduction
The “Apgar Score,” a simple statistical model of five physiological signs, devised by Dr. Virginia Apgar in 1952 [1] to decipher immediate neonatal well being, marked an unprecedented paradigm shift in neonatal care by pragmatizing the earlier deterministic outlook of newborn resuscitation. Over the last five decades, its ceaseless observance soon after birth in every modern hospital has transformed Apgar scoring into a new form of methodological dialect either for neonatal status at birth or in reference to the level of perinatal care [2]. Yet, doubts of its being decrepit have also been voiced regularly in literature. This review, on the other hand, is a dispassionate attempt to triangulate the Apgar score by using a cross disciplinary approach and highlighting the differences that exist between actual everyday practice and accepted standards of Apgar scoring in contrasting populations of world.
Section snippets
Overview
An emerging field in psychometrics, better known as clinimetrics [3], has offered a new avenue of evaluating Apgar scoring—characteristics of its components, level of interaction in them, its scoring pattern as well as the reliability and validity of the score in the present context of rapidly growing perinatal and neonatal medicine [4]. This will yield insights that have important implications for the improvement in the principles and performance of Apgar scoring. The Apgar score, an example
Sensitivity and specificity of Apgar score as a predictive index
When predictive potential of the Apgar score in optimizing newborn care is the subject of debate, the substantiation of its role, at present, is not deemed unequivocal [23], [24]. To be pragmatic, no matter how simple Apgar scoring may be, its interpretation has the potential to initiate a cascade of unanticipated decisions, both clinically as well as medicolegally [23], [45], [46]. As an isolated marker of birth asphyxia (defined by umbilical cord arterial pH), scoring criteria are misleading
Status of Apgar scoring: constraints in contrasting populations
Despite great strides made by neonatology the world over, it still behooves many clinicians to consider Apgar as an end but not the means of perinatal evaluation as well as a product and not the process of neonatal transition, thereby posing clear and tangible threats to Apgar scoring. The presently recommended protocol of neonatal resuscitation has completely grounded the rhetoric boosting Apgar score as a prerequisite for resuscitation, which is already in progress when the first Apgar is
Survival of Apgar score for the last five decades
Though the Apgar score signaled a new era in the history of neonatology, the issue of its survival in last five decades needs a reappraisal. Figure 2 depicts some of the reasons for its legendary status.
Other elusive yet important reasons for its survival are enumerated below:
- 1.
Studies glorifying Apgar had always compared it for its selective strengths with other tools. It is more objective than the breathing and crying times used previously? Although the latter are still more feasible in
Conclusion
In summary, the growing chorus of critical voices over the years describing the Apgar score as “imperfect,” “outmoded,” “pensioned off,” and “antiquated” have coaxed it downstairs, at least by few steps [44], [67], [71]. Yet, by illustrating the ambiguities and uncertainties, we do not mean to suggest that newborn infants should be denied its putative benefits especially in the light of some recent studies [25], [50], [51]. But to maximize its benefits, use of the Apgar score definitely needs
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2011, Early Human DevelopmentCitation Excerpt :It was therefore concluded: “Although imperfect, it would seem a little premature to pension the Apgar off yet” [36]. At the moment, the Apgar-Score remains the only well recognised method for an objective assessment of the newborn infant [27]; however, there is a need for calibration of the Apgar-Score [37]. One major reason for its limited use is the missing agreement on how to use the Apgar-Score in infants receiving interventions and in very immature infants.
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