Review
A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings

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Abstract

Objective

To triangulate the Apgar score by using a crossdisciplinary approach and highlighting the differences that exist between actual everyday practice and accepted standards of scoring in contrasting populations of the world.

Study design and setting

Clinimetrics review of Apgar scoring.

Results

The Apgar scoring has weighting problems, rigid categorization, redundancy and subjectivity in its variables. Poor inter-rater reliability and equivocal validity mark its use in the present milieu. The ceiling and floor effects further hamper the evaluative responsiveness of scoring. Moreover, despite some recent evidence in its favor, the Apgar score has poor calibration when used as an isolated criterion to predict mortality and long-term morbidity, particularly in preterms. Also, the vigor of resuscitation (nature and duration), in essence, is beyond the realm of the Apgar score in contemporary resuscitation guidelines.

In developed nations, with rapidly decreasing age of viability, and alternative modes of childbearing, threats to Apgar are more ominous today than before. On the other hand, in developing countries, feasibility problems due to unattended home deliveries and barriers to effective scoring in the overburdened and understaffed hospitals cast doubts about its accuracy as a measure of neonatal well-being.

Conclusion

Use of the Apgar score definitely needs to be contextualized 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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