Ī further problem in documenting the neonatal adaptation in the delivery room may be due to the fact that many Health Care Providers (HCPs) are not sufficiently trained in assessing the AS which is mirrored by a high inter-observer variation. Elements of the score such as skin colour, muscle tone and reflex irritability very much depend on the maturation, and thus on the gestational age of the newborn infant. Livingston and co-workers showed that the inter-observer variability was smaller when assessing the AS in infants born at term than in those born preterm. This fact questions the prognostic significance of the AS for this population of preterm patients although it has been suggested that low AS may be of predictive value regarding neonatal mortality of infants born premature. When compared to term infants, preterm infants may well be given lower AS only due to the immaturity itself, even when the immediate adaptation is not impeded by cardio-respiratory problems. No consistent data are available on the interpretation and on the applicability of the AS in premature infants. ĭue to the advances in neonatal medicine over the last 50 years, an increasing number of very preterm infants are being offered resuscitation measures and intensive care yet the AS has not been adjusted to this population of immature infants. Over the past decades, a low AS at 5 minutes of life has also gained interest regarding its prediction of neonatal mortality and long-term morbidity. From a locally developed clinical assessment tool, it rapidly gained international acceptance as the first standardized method, and eventually as the “gold standard” to evaluate and to document the immediate neonatal adaptation as well as the efficacy of neonatal stabilisation and resuscitation measures in the delivery room. The Apgar score, as designed by Virginia Apgar in 1953, was primarily developed to assess the effect of maternal analgesia and anaesthetic during labor and different obstetrics techniques on the immediate neonatal adaptation of infants born at term, and also to guide neonatal resuscitation measures directly after birth.
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