Apgar Score - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
Please can you tell me the conditions in which apgar score may be falsely low and falsely high?
Answer
The neonatal resuscitation program (NRP) guidelines state that "Apgar scores should not be used to dictate appropriate resuscitative actions, nor should interventions for depressed infants be delayed until the 1-minute assessment." However, an Apgar score that remains 0 beyond 10 minutes of age may be useful in determining whether additional resuscitative efforts are indicated. The Apgar score has been used inappropriately in term infants to predict specific neurologic outcome. Because there are no consistent data on the significance of the Apgar score in preterm infants, in this population the score should not be used for any purpose other than ongoing assessment in the delivery room. The Apgar score is an expression of the infant's physiologic condition, has a limited time frame, and includes subjective components. In addition, the biochemical disturbance must be significant before the score is affected. Elements of the score such as tone, color, and reflex irritability partially depend on the physiologic maturity of the infant. The healthy preterm infant with no evidence of asphyxia may receive a low score only because of immaturity. A number of factors may influence an Apgar score, including but not limited to drugs, trauma, congenital anomalies, infections, hypoxia, hypovolemia, and preterm birth. The incidence of low Apgar scores is inversely related to birth weight, and a low score is limited in predicting morbidity or mortality. Accordingly, it is inappropriate to use an Apgar score alone to establish the diagnosis of asphyxia. Back to All Questions

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