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The use of Apgar scoring for premature newborns remains widespread, despite controversy about its reliability in measuring health status in these newborns. A recent study, supported by the Agency for Healthcare Research and Quality (HS08385), found that low Apgar scores in premature newborns are associated with increased neonatal morbidity and mortality.
The reliability of Apgar scores in premature newborns has been called into question because several criteria used to determine Apgar scores for full-term newborns (muscle tone, reflex irritability, and respiratory effort) are developmentally determined. Thus, low Apgar scores in term infants mean that some medical problem might be the cause of not meeting developmental milestones. Many argue that low Apgar scores in premature newborns may reflect neurodevelopmental immaturity more than fetal compromise. However, the findings from this study suggest otherwise. This study examined the antenatal and early neonatal correlates of low Apgar scores (less than 3 at 1 minute and less than 6 at 5 minutes) for a group of 852 preterm infants (23 to 34 weeks' gestation) born during a 34-month period between 1984 and 1987 at three hospitals in central New Jersey. Low Apgar scores were associated with increased neonatal morbidity and mortality as well as more neonatal interventions and complications in preterm newborns.
Premature newborns with low Apgar scores received more cardiopulmonary resuscitation in the delivery room and in the first 6 to 8 hours of neonatal intensive care, and they had significantly higher mortality rates than those with good Apgar scores (54 vs. 26 percent for 23- to 28-week infants, 30 vs. 6 percent for 29- to 34-week infants). Premature newborns with low scores required significantly more positive pressure ventilation, intubation, cardiopulmonary resuscitation, umbilical catheterization, and intravenous medications. The researchers conclude that Apgar scores are a useful tool for assessing neonatal short-term prognosis and the likelihood of intensive care among preterm newborns.
See "Antecedents and neonatal consequences of low Apgar scores in preterm newborns," by Barry Weinberger, M.D., Mujahid Anwar, M.D., Thomas Hegyi, M.D., and others, in the March 2000 Archives of Pediatric and Adolescent Medicine 154,
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