Variatie in apgarscore bij beoordeling van neonaten die worden beademd

To investigate the inter-assessor variation in the score for the respiration of neonates in a reanimation setting.

Design

Survey with trial cases.

Method

Registrars in paediatrics, paediatricians and neonatologists determined the Apgar score of neonates in 3 different trial cases in which artificial respiration was given: respiration with a mask and balloon in a neonate with irregular breathing, respiration of an asphyctic neonate, and respiration of a premature infant born at 25 weeks of gestation. The 2 last cases were intubated and respirated within 10 minutes after birth. The participants gave the usual score of ‘0’, ‘1’ or ‘2’ to each of the 5 separate components and also a total score.

Results

The response to the survey was 91: 166 of the 183 questionnaires could be analysed. There was a marked variation in the assessment of the respiration in neonates that had been intubated and respirated within 10 minutes after birth. The assessment of the respiration in cases 2 and 3 showed the largest differences in the score, with SD: 0.90 and SD: 0.84, respectively. A large number of the participants gave the maximum score for respiration to the respirated asphyctic neonate (27) and to the respirated premature infant born at 25 weeks of gestation (47).

Conclusion

The assessment of the Apgar score of respirated neonates showed large differences among paediatric professionals. In an attempt to achieve better agreement, a respirated neonate that shows no spontaneous respiration should be given the minimum score for the respiration (‘0’) and a neonate that is respirated in connection with irregular or superficial breathing should be given the score ‘1’.

Ned Tijdschr Geneeskd. 2006;150:2497-500