Apgar scores and asphyxia. Results of a study and proposal for a clinical grading system

The Apgar score (AS) was devised in 1953 as a simple system for classifying neonatal condition at 1 minute and was later modified to include status at 5 minutes. However, studies have documented pitfalls, e.g. a poor correlation between AS and acid-base status. We studied 35 infants born at term. ASs were assigned by two nurses not involved in the delivery, and antepartum and postpartum events were noted. We confirmed the following: (i) labour ward staff tend to overestimate ASs; (ii) there is a poor correlation between the AS and acid-base status; and (iii) the labour ward staff's decision to resuscitate with intermittent positive-pressure respiration (IPPR) correlates with the AS but not with blood gas status. Infants with initially low ASs and/or a brief requirement for IPPR may be recorded by medical or nursing staff as being asphyxiated at birth. Our results show that low ASs may be associated with normal acid-base status and vice versa. In order further to define asphyxia, we therefore propose that a grading system which incorporates clinical data and the AS be used. Use of such a system would facilitate inter-area comparisons of grades of asphyxia encountered, efficacy of intervention programmes and developmental outcome of asphyxiated neonates.