EXPANDED APGAR SCORE -AAP

Expanded Apgar score reporting form. Scores should be recorded in the appropriate place at specific time intervals. The additional resuscitative measures (if appropriate) are recorded at the same time that the score is reported by using a checkmark in the appropriate box. The comment box is used to list other factors, including maternal medications and/or the response to resuscitation between the recorded times of scoring. ETT, endotracheal tube; PPV/NCPAP, positive pressure ventilation/nasal continuous positive airway pressure

RECOMMENDATIONS

1. The Apgar score does not predict individual neonatal mortality orneurologic outcome and shouldnot be used for that purpose.

2. It is inappropriate to use the Apgarscore alone to establish the diagnosisof asphyxia. The term asphyxia,which describes a process of varying severity and duration rather than an end point, should not be applied to birth events unless specific evidence of markedly impaired intrapartum or immediate postnatal gas exchange can be documented.

3. When a newborn infant has an Apgar score of 5 or less at 5 minutes, umbilical arterial blood gas samples from a clamped section of the umbilical cord should be obtained. Submitting the placenta for pathologic examination may be valuable.

4. Perinatal health care professionals should be consistent in assigning an Apgar score during resuscitation; therefore, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.