1
|
Michel AD, Lowe NK. Accuracy and Interrater Agreement of Registered Nurses' Assignment of Apgar Scores to Standardized Clinical Vignettes. Clin Nurs Res 2023; 32:452-462. [PMID: 36788427 DOI: 10.1177/10547738231155266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of our study was to test whether registered nurses assign the correct Apgar score when provided all pertinent data, whether they assign an Apgar score even if all pertinent data are not provided, and to evaluate the Apgar score's interrater agreement. We conducted a REDCap survey and provided nurses with color photograph/vignette combinations of neonates, some of which lacked pertinent data points needed to correctly assign Apgar scores. Over 90% of study participants assigned Apgar scores even if data points for heart rate or respiratory effort were omitted. Participants' correct assignment of the component score for respiratory effort was affected by the description of the respiratory effort and whether neonatal heart rate was known. Interrater agreement was generally low to moderate. Our findings are consistent with earlier findings and support the conclusion that the Apgar score requires significant revision or needs to be retired and replaced.
Collapse
|
2
|
Rozycki HJ, Yitayew M. The Apgar score in clinical research: for what, how and by whom it is used. J Perinat Med 2022; 51:580-585. [PMID: 36410713 DOI: 10.1515/jpm-2022-0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To review how the Apgar score is used in published clinical research as well as who uses it, and how this may have changed between 1989-90 and 2018-19. METHODS Pubmed search for English publications using MeSH Terms "apgar score" OR "apgar" AND "score" AND "humans" for epochs 1989-90 & 2018-19. The location and specialty of first author, primary purpose and how the Apgar score was used was recorded. RESULTS There was a 61% increase in number of publications in 2018-19 compared to 1989-90, from all regions except North America. The most common purpose for using the Apgar was to assess newborn status after pregnancy/delivery interventions. There were 50 different definitions of a significant score. Definition of significance was influenced by specialty in 2018-19 and by study purpose in both epochs. CONCLUSIONS Most studies using the Apgar score are focused on the mother. There is no consistent definition of a significant score. Development of any future newborn assessment tools should account for the multiple purposes for which the Apgar score is used.
Collapse
Affiliation(s)
- Henry J Rozycki
- Division of Neonatal Medicine, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Miheret Yitayew
- Division of Neonatal Medicine, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| |
Collapse
|
3
|
Abstract
BACKGROUND The Apgar score is the most common score used to quantify neonatal status after birth. It is routinely used in clinical practice and research. However, since its introduction there have been significant changes in peripartum and neonatal management, our understanding of neonatal physiology, and changes in data analysis capabilities. PURPOSE To assess the Apgar score's reliability and validity in the context of today's clinical and research environments. METHOD PubMed was searched using the term "Apgar." Just over 22,000 titles were identified. Full-text articles were obtained if they addressed the Apgar score's use, reliability, and validity, or if the score was a primary outcome measure. This was followed by a hand search using the same criteria. The 505 identified articles build the basis for this discussion of the Apgar score's reliability and validity. FINDINGS Multiple positive and negative aspects of the Apgar score's reliability and validity were identified. Some facets needed to evaluate reliability and validity do not seem to have been addressed in the literature. Overall, the identified concerns can introduce bias into outcomes obtained via the use of the Apgar score in both clinical practice and research. IMPLICATIONS FOR PRACTICE The Apgar score is no longer used to determine neonatal management in the delivery room. IMPLICATIONS FOR RESEARCH The use of the Apgar score in research may introduce bias into outcomes. As discussed in the Video Abstract, researchers need to address and improve the score's weaknesses or consider developing a new tool better suited to today's research needs. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=45.
Collapse
|
4
|
Niemuth M, Küster H, Simma B, Rozycki H, Rüdiger M, Solevåg AL. A critical appraisal of tools for delivery room assessment of the newborn infant. Pediatr Res 2021:10.1038/s41390-021-01896-7. [PMID: 34969993 DOI: 10.1038/s41390-021-01896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Assessment of an infant's condition in the delivery room represents a prerequisite to adequately initiate medical support. In her seminal paper, Virginia Apgar described five parameters to be used for such an assessment. However, since that time maternal and neonatal care has changed; interventions were improved and infants are even more premature. Nevertheless, the Apgar score is assigned to infants worldwide but there are concerns about low interobserver reliability, especially in preterm infants. Also, resuscitative interventions may preclude the interpretation of the score, which is of concern when used as an outcome parameter in delivery room intervention studies. Within the context of these changes, we performed a critical appraisal on how to assess postnatal condition of the newborn including the clinical parameters of the Apgar score, as well as selected additional parameters and a proposed new scoring system. The development of a new scoring system that guide clinicians in assessing infants and help to decide how to support postnatal adaptation is discussed. IMPACT: This critical paper discusses the reliability of the Apgar score, as well as additional parameters, in order to improve assessment of a newborn's postnatal condition. A revised neonatal scoring system should account for infant maturity and the interventions administered. Delivery room assessment should be directed toward determining how much medical support is needed and how the infant responds to these interventions.
Collapse
Affiliation(s)
- Mara Niemuth
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Helmut Küster
- Clinic for Pediatric Cardiology, Intensive Care and Neonatology, University Medical Center Göttingen, Göttingen, Germany
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Henry Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anne Lee Solevåg
- The Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
| |
Collapse
|
5
|
Kot K, Kosik-Bogacka D, Łanocha-Arendarczyk N, Malinowski W, Szymański S, Mularczyk M, Tomska N, Rotter I. Interactions between 14 Elements in the Human Placenta, Fetal Membrane and Umbilical Cord. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091615. [PMID: 31071998 PMCID: PMC6540151 DOI: 10.3390/ijerph16091615] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
The aim of the study was to investigate relationships between the concentrations of macroelements (Ca), microelements (Cr, Cu, Fe, Mn, Mo, Ni, Sn, Sr, V, Zn) and heavy metals (Ag, Cd, Pb) in the placenta, fetal membrane and umbilical cord. Furthermore, we examined relationships between the concentrations of these metals in the studied afterbirths and maternal age, gestational age, placenta parameters (breadth, length, weight) and newborn parameters (length, weight and Apgar score). This study confirms previously reported Zn-Cd, Pb-Cd and Ni-Pb interactions in the placenta. New types of interactions in the placenta, fetal membrane and umbilical cord were also noted. Analysis of the correlations between metal elements in the afterbirths (placenta, fetal membrane and umbilical cord) and biological parameters showed the following relationships: maternal age and Mn (in the fetal membrane); gestational age and Cr, Fe, Zn (in the fetal membrane), Ag and Cu (in the umbilical cord); newborn’s length and Sr (in the placenta), Ag (in the umbilical cord); newborn’s weight and Sr (in the placenta), Cu (in the fetal membrane), Ag (in the umbilical cord); Apgar score and Ca, Cr and Ni (in the umbilical cord); placenta’s length and Cr and Sn (in the fetal membrane), Cu (in the umbilical cord); placenta’s width and Mo, Pb (in the placenta) and placenta weight and Sr (in the placenta), Ag, Fe, Mn (in the fetal membrane). The results show the influence of metals on the placenta, mother and newborn parameters, and the same point indicates the essential trace elements during the course of pregnancy.
Collapse
Affiliation(s)
- Karolina Kot
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Danuta Kosik-Bogacka
- Independent of Pharmaceutical Botany, Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Witold Malinowski
- Department of Obstetrical and Gynecological Nursing, Pomeranian Medical University in Szczecin, Zolnierska 48, 71-210 Szczecin, Poland.
| | - Sławomir Szymański
- Department of Obstetrical and Gynecological Nursing, Pomeranian Medical University in Szczecin, Zolnierska 48, 71-210 Szczecin, Poland.
| | - Maciej Mularczyk
- Chair and Department of Human and Clinical Anatomy, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Natalia Tomska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Zolnierska 48, 71-210 Szczecin, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, Zolnierska 48, 71-210 Szczecin, Poland.
| |
Collapse
|
6
|
Bank-Nielsen PI, Long M, Bonefeld-Jørgensen EC. Pregnant Inuit Women's Exposure to Metals and Association with Fetal Growth Outcomes: ACCEPT 2010⁻2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1171. [PMID: 30939809 PMCID: PMC6479494 DOI: 10.3390/ijerph16071171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/23/2022]
Abstract
Environmental contaminants such as heavy metals are transported to the Arctic regions via atmospheric and ocean currents and enter the Arctic food web. Exposure is an important risk factor for health and can lead to increased risk of a variety of diseases. This study investigated the association between pregnant women's levels of heavy and essential metals and the birth outcomes of the newborn child. This cross-sectional study is part of the ACCEPT birth cohort (Adaption to Climate Change, Environmental Pollution, and dietary Transition) and included 509 pregnant Inuit women ≥18 years of age. Data were collected in five Greenlandic regions during 2010⁻2015. Population characteristics and birth outcomes were obtained from medical records and midwives, respectively, and blood samples were analyzed for 13 metals. Statistical analysis included one-way ANOVA, Spearman's rho, and multiple linear and logistic regression analyses. The proportion of current smokers was 35.8%. The levels of cadmium, chromium, and nickel were higher compared to reported normal ranges. Significant regional differences were observed for several metals, smoking, and parity. Cadmium and copper were significantly inversely related to birth outcomes. Heavy metals in maternal blood can adversely influence fetal development and growth in a dose⁻response relationship. Diet and lifestyle factors are important sources of toxic heavy metals and deviant levels of essential metals. The high frequency of smokers in early pregnancy is of concern, and prenatal exposure to heavy metals and other environmental contaminants in the Greenlandic Inuit needs further research.
Collapse
Affiliation(s)
- Per I. Bank-Nielsen
- Centre for Arctic Health and Molecular Epidemiology, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark; (P.I.B.-N.); (M.L.)
| | - Manhai Long
- Centre for Arctic Health and Molecular Epidemiology, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark; (P.I.B.-N.); (M.L.)
| | - Eva C. Bonefeld-Jørgensen
- Centre for Arctic Health and Molecular Epidemiology, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark; (P.I.B.-N.); (M.L.)
- Greenland Center for Health Research, University of Greenland, 3900 Nuuk, Greenland
| |
Collapse
|
7
|
Witcher TJ, Jurdi S, Kumar V, Gupta A, Moores RR, Khoury J, Rozycki HJ. Neonatal Resuscitation and Adaptation Score vs Apgar: newborn assessment and predictive ability. J Perinatol 2018; 38:1476-1482. [PMID: 30093618 DOI: 10.1038/s41372-018-0189-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the non-inferiority of an alternative to the Apgar score. STUDY DESIGN The Neonatal Resuscitation and Adaptation Score (NRAS) was recorded in parallel to the Apgar score by a resuscitation team at deliveries. Correlation between the systems was assessed, as well as the predictive ability of NRAS and Apgar scores for mortality or short-term morbidities. RESULTS A total of 340 infants were in the study group. The two scores correlated strongly (r = 0.87 and 0.83 at 1 and 5 min, respectively). Those needing ventilation at 48 h of life had a 5-min NRAS < 7 in 23/26 vs Apgar < 7 (23/36, p = 0.001). A low (0-3) 1-min NRAS score was more predictive of death, 53% vs 17%, p = 0.0065. CONCLUSIONS NRAS correlates with Apgar status assessment, and identifies newborns who die or may require further care better than the Apgar score.
Collapse
Affiliation(s)
- Teresa J Witcher
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Shadi Jurdi
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Vidhya Kumar
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Aditi Gupta
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Russell R Moores
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Joseph Khoury
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Henry J Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
| |
Collapse
|