Abstract
The five objective criteria used in the Apgar score to assess the newborn include four signs (tone, reflex irritability, color, respiratory drive) that depend upon developmental maturity. The immature infant, with typically flaccid muscle tone is penalized by the Apgar method for developmental immaturity. We hypothesized that in nonasphyxiated fetuses, Apgar scores should correlate directly with gestational age (lower scores with decreasing maturity). 62 parturients (gestation: 23-42 weeks) were prospectively enrolled. By objective documentation of pregnancy history, labor complications, fetal heart rate tracings, cord blood pH & BE, their fetuses were judged as normal at the time of delivery. Direct relationship between Apgar scores and gestational age following a linear regression (y=.34x-4.8 at 1′, r=0.82; y=.28x-1.6 at 5′, r=0.77) was observed. Analysis of the total score into components reveals heart rate to be least influenced by maturity. Respiratory effort and muscle tone increase with increasing maturity. Skin color improves with development at the 5′ score. Reflex irritability trends upward but with more variability at 1′ than 5′. These data suggest that 1) the standard Apgar score may not be appropriate for the assessment of fetal well-being in premature infants, 2) scores thought representative of asphyxia in more mature newborns may not represent asphyxia in immature infants, and 3) these normative data are useful in the assessment of fetal status at various levels of maturity.
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Catlin, E., Carpenter, M., Brann, B. et al. 1360 THE APGAR SCORE REVISITED: DEVELOPMENTAL PATTERNS IN “OPTIMAL” NEWBORNS. Pediatr Res 19, 337 (1985). https://doi.org/10.1203/00006450-198504000-01384
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DOI: https://doi.org/10.1203/00006450-198504000-01384