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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Positive changes among very low birth weight infant Apgar scores that are associated with the Neonatal Resuscitation
Daksha Patel1, Zdzislaw H Piotrowski
1Saint Joseph Hospital, Resurrection Health Care and Northwestern University Medical School, Chicago, IL 60657, USA.
Insights
The Neonatal Resuscitation Program (NRP) improved Apgar scores in very low birth weight newborns in Illinois. This standardized training demonstrated clinical effectiveness in hospitals, reducing newborn morbidity and mortality.
Area of Science:
- Neonatal care
- Pediatric resuscitation
- Clinical effectiveness studies
Background:
- The Neonatal Resuscitation Program (NRP) was implemented in Illinois in 1987.
- Its goal was to standardize resuscitation knowledge and skills to reduce newborn morbidity and mortality.
Purpose of the Study:
- To evaluate if statewide NRP implementation in Illinois hospitals positively impacted Apgar scores.
- Specifically examining outcomes in very low birth weight newborns.
Main Methods:
- Retrospective study design comparing outcomes before and after NRP implementation.
- Analyzed Apgar scores (1- and 5-minute), focusing on rates of low (0-6) vs. high (7-10) scores and score improvement.
- Considered maternal characteristics, birth weight groups (500-1499g), and hospital levels (I, II, III).
Main Results:
- A significantly higher proportion of infants achieved higher 1- and 5-minute Apgar scores post-NRP implementation.
- Improvements were observed overall, in Level II and III hospitals, and across all studied weight groups.
- Newborns with low 1-minute Apgar scores were 81% more likely to have a higher 5-minute Apgar score after NRP.
Conclusions:
- The NRP implementation was associated with significant improvements in Apgar scores.
- This study provides empirical support for the clinical effectiveness of NRP training in Illinois hospitals.
Objective:
The American Academy of Pediatrics and American Heart Association sponsored Neonatal Resuscitation Program (NRP) was started in Illinois 1987 to standardize knowledge and skills for successful resuscitation to decrease newborn morbidity and mortality. This study evaluated the hypothesis that the statewide NRP in Illinois hospitals was associated with positive outcomes in the Apgar scores among very low birth weight newborns.
Study Design:
A retrospective design was used to compare the (a) different rates of lower (0-6) and higher (7-10) 1- and 5-minute Apgar scores and (b) positive change from a lower 1-minute to a higher 5-minute Apgar score before and after NRP was started. Analyses included maternal characteristics, birth weight groups (grams: 500-749, 750-999, 1000-1249, 1250-1499), and hospital levels (I, II, III).
Results:
A significantly higher proportion of infants had a higher 1-minute and a higher 5-minute Apgar score after NRP, overall, for Level II and II+ hospitals and for each weight group. Logistic regression indicated that newborns with low 1-minute Apgar scores were 81% more likely to have a higher 5-minute Apgar score after NRP.
Conclusion:
Significant improvement in Apgar score occurred after NRP. Empirical support is demonstrated for the clinical effectiveness of NRP instruction in Illinois hospitals.