Apgar results depend on who scores the test

By David Douglas

NEW YORK (Reuters Health) - The 5-minute Apgar score assigned to infants immediately after delivery varies considerably among different observers, Australian investigators concluded after viewing the video recordings of newborn resuscitations.

"The implication of this study," lead researcher Dr. Colm P. F. O'Donnell told Reuters Health, "is that we need more objective measures of infant well-being in the minutes after birth" to judge the effectiveness of resuscitation efforts in both clinical practice and trials.

The Apgar score, which was developed by anesthesiologist Dr. Virginia Apgar in 1953, rates a newborn infant's respiration, heart rate, muscle tone, reflexes and skin color, O'Donnell of Royal Women's Hospital Melbourne and colleagues note. All measures, other than heart rate, are based on visual inspection. The maximum score is 10.

To examine variability in the scores, the researchers showed 10-second clips of 30 newborns taken at 5 minutes of age to 42 observers, consisting of neonatal, obstetric medical, and nursing staff. The observers then scored the infants themselves.

The scores showed large variability in all four subjective elements, regardless of the infant's level of illness, the investigators report in the Journal of Pediatrics.

The average score given by those who had actually attended the delivery was 2.4 points higher than that of the video observers. There was no evidence that a particular staff group was substantially associated with the level of discrepancy.

In an accompanying editorial, Dr. William Keenan of Saint Louis University, Missouri calls the data "appalling" but notes that they "are consistent with previous findings."

For the Apgar score to remain of value, it will need to be more reliable; the sources of variation must be identified; performance expectations should be calified, better training is needed and investment in quality control must be made, he concludes.

SOURCE: Journal of Pediatrics, October 2006.