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OB: Apgar RevisitedFrom: art fougner, md (evsono@pipeline.com)Fri Jul 16 07:30:59 2004
In this week's British Medical Journal - Correct use of the Apgar score for resuscitated and intubated newborn babies: questionnaire study Commentary The assessment of the Apgar score varied greatly among participants, particularly when scoring respiratory effort in intubated newborn babies. The original definition for scoring respiratory effort states that an apnoeic infant should score 0, and an infant who "breathed and cried lustily" should score 2.1 2 All other types of respiratory effort, such as irregular shallow ventilation, should score 1.1 2 We propose therefore that an infant who is apnoeic and requires intubation and ventilation should receive the minimum value of 0 for respiratory effort, not withstanding the fact that normoxia may be achieved through adequate artificial ventilation. If an infant requires artificial ventilation at birth due to irregular or shallow ventilation, he or she should score 1. To assess whether an artificially ventilated infant is apnoeic or not, ventilation should be stopped briefly, when possible, to check for the presence of spontaneous respiratory movements. Scores for colour and reflex irritability also varied widely. Although acrocyanosis (cases 1 and 3) should score 1, and a cry in response to a brisk tangential slap of the soles of the feet (case 1) should score 2, actual scores were incorrect in a third of cases. For the Apgar score to survive another 50 years, uniformity in scoring is paramount. Paediatric professionals should follow Apgar's original definitions more strictly, and consensus on scoring intubated newborn babies should be reached. http://bmj.bmjjournals.com/cgi/content/full/329/7458/143
-- art fougner, md ich bin ein New Yorker
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