Related Experiment Video
Updated: May 17, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Assessing newborn scoring with each resuscitation (ANSWER): Protocol for identifying and testing an Apgar score for
Henry J Rozycki1, Elizabeth E Foglia2, Miheret S Yitayew1
1Division of Neonatal Medicine, Children's Hospital of Richmond at VCU and Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America.
Background:
The status of infants in the minutes after birth has been summarized by the Apgar score for the last 70 years and is applied at most medically attended deliveries around the world. It has not, however, adapted to changes in neonatal resuscitation over the decades. There are issues with application to premature newborns, how to account for the interventions outlined in the Newborn Resuscitation Program (NRP), inter-rater reliability, and local custom. Developing a modern newborn assessment score will require a series of steps, the first of which is to identify which observations or data can best differentiate a normal newborn transition from an abnormal one.
Methods:
Video recordings of at least 35 random normal (meeting NRP goals for heart rate and saturation without intervention, normal physical exam and requiring only normal postnatal care) and 35 random abnormal (not meeting at least 2 normal criteria) from 7 centers participating in the VERIFI study. The presence or absence of observable elements, including vital signs, appearance, and interventions will be recorded every 30 seconds for the first 5 minutes of life. Observations, as well as any changes over time or after intervention will be compared between normal and abnormal, and those that are significant and independent based on logistic regression will become candidate newborn assessment score components.
Expected Results:
There are likely to be ten or more observations/elements from videos of the first five minutes of life that will differ between normal and abnormal newborns, and these will be tested in all combinations to identify the 1-3 score sets that will be applied to a new set of VERIFI videos to identify which has the best sensitivity/specificity.
Conclusions:
Bringing newborn assessment into modern practice will build on the legacy of Dr. Apgar. A series of steps, beginning with identifying the observations/elements that best identify newborns who may need further care can lead to a universal validated tool for the 21st century.
Related Concept Videos
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps: