Evaluation of interobserver agreement of apgar scoring in preterm infants

Monuj Bashambu, Halana Whitehead, Anna Maria Hibbs, Richard J. Martin, Monika Bhola

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Apgar scoring is accepted by medical professionals both as a measure of the infant 's clinical status and the infant 's response to resuscitation. Recent studies, however, have suggested significant variability when used for scoring preterm infants. We hypothesized that agreement in Apgar scoring would improve with increasing gestational age and at low levels of respiratory support. We also hypothesized that grimace and muscle tone would demonstrate the least agreement. METHODS: Neonatologists from the Perinatal Section of the American Academy of Pediatrics were presented with 4 film clip cases via a secure online survey: (1) full-term infant in room air; (2) 28 weeks' gestation infant with continuous positive airway pressure; (3) 28 weeks' gestation infant intubated; and (4) 24 weeks' gestation infant intubated. Participants were shown 30-second clips at 1, 5, and 10 minutes of life and were asked to provide Apgar scores. κ coefficients were used to compare agreement for each component. RESULTS: A total of 335 neonatologists participated in the survey. κ coefficients in the full-term infant for respiratory effort (0.94, 0.91), grimace (0.91, 0.90), and muscle tone (0.91, 0.89) demonstrated almost perfect agreement at 1 and 5 minutes. For preterm infants, respiratory effort (range: 0.07-0.40), muscle tone (range: 0.10-0.75), and grimace (range: 0.11-0.71) all demonstrated disagreement at 1, 5, and 10 minutes of life unless the infants were apneic and limp. CONCLUSIONS: An improved delivery room score that decreases variability among medical care professionals is needed to accurately reflect the clinical status of preterm infants.

Original languageEnglish (US)
JournalPediatrics
Volume130
Issue number4
DOIs
StatePublished - Jan 1 2012

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Premature Infants
Surgical Instruments
Pregnancy
Muscles
Delivery Rooms
Continuous Positive Airway Pressure
Apgar Score
Motion Pictures
Resuscitation
Gestational Age
Air
Pediatrics

Keywords

  • Agreement
  • Apgar score
  • Preterm infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bashambu, M., Whitehead, H., Hibbs, A. M., Martin, R. J., & Bhola, M. (2012). Evaluation of interobserver agreement of apgar scoring in preterm infants. Pediatrics, 130(4). https://doi.org/10.1542/peds.2012-0368

Evaluation of interobserver agreement of apgar scoring in preterm infants. / Bashambu, Monuj; Whitehead, Halana; Hibbs, Anna Maria; Martin, Richard J.; Bhola, Monika.

In: Pediatrics, Vol. 130, No. 4, 01.01.2012.

Research output: Contribution to journalArticle

Bashambu, M, Whitehead, H, Hibbs, AM, Martin, RJ & Bhola, M 2012, 'Evaluation of interobserver agreement of apgar scoring in preterm infants', Pediatrics, vol. 130, no. 4. https://doi.org/10.1542/peds.2012-0368
Bashambu, Monuj ; Whitehead, Halana ; Hibbs, Anna Maria ; Martin, Richard J. ; Bhola, Monika. / Evaluation of interobserver agreement of apgar scoring in preterm infants. In: Pediatrics. 2012 ; Vol. 130, No. 4.
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