37 A Specified Type of Apgar - Results of the International Test-Apgar Study

Background: There is considerable variation in assigning Apgar scores. Definitions are required to apply Apgar score under clinical conditions such as preterm delivery or resuscitation [Rudiger et al. ActaPaed'09:98;1433-36]. American Academy of Pediatrics suggested an additional form for resuscitated infants [Ped'06:117;1444-47], however, its predictive value was not tested until now. Aim: Test the prognostic value of a specified Apgar score and the AAP-suggestion to predict short term neonatal outcome of preterm infants. Methods: Comparison of the conventional Apgar with the specified Apgar score and AAP-suggestion in an international prospective study. Inclusion criteria: gestational age below 33 weeks, born within participating centres. Following data were obtained: perinatal characteristics; the infant's condition during first 10 minutes; discharge data on mortality and morbidity. Results: Of the 2169 infants that were screened, 1930 were included with the following birth characteristics: GA 28±2.5, birthweight 1164±400g, umbilical artery pH 7.3±0.1. The specified Apgar score was significantly higher than the conventional score. Mortality of included infants was 11%. Comparison of infants who died or survived showed no differences in conventional Apgar score [median (range) 7(5-8) vs. 8(7-9)], however, significant differences in the specified score [6(4-7) vs. 9(8-10)]. 6% of infants did not require any support (according to AAP-form) during the first 10 minutes, infants who did not survive the neonatal period required significantly more support during the first 10 minutes. Discussion: It is the first presentation of the TEST-APGAR study-results providing data to improve the usage of Apgar-Score in infants requiring support in the delivery room.