title: Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar).
abstract: BACKGROUND
  Since an objective description is essential to determine infant's postnatal condition and efficacy of interventions, two scores were suggested in the past but weren't tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.
  
  
  METHODS
  Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.
  
  
  RESULTS
  Of 2150 eligible newborns, data on 1855 infants with a mean GA of 28(6/7) ± 2(3/7) weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.
  
  
  CONCLUSIONS
  The Combined-Apgar allows a more appropriate description of infant's condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.
  
  
  BACKGROUND
  clinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. mario.ruediger@uniklinikum-dresden.de.
authors.forename: Mario
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authors.lastname: Rüdiger
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. nicole.braun@icloud.com.
authors.forename: Nicole
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authors.affiliation: Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA. Jacob.Aranda@downstate.edu.
authors.forename: Jacob
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authors.affiliation: Division of Neonatology, University & Polytechnic Hospital La Fe, 46009, Valencia, Spain. maraca@alumni.uv.es.
authors.forename: Marta
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authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. renate.bergert@uniklinikum-dresden.de.
authors.forename: Renate
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authors.affiliation: Faculty Hospital, Department of Neonatology, 94001, Nové Zámky, Slovakia. alica2008@hotmail.com.
authors.forename: Alica
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authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras Medical School, Rio, Patras, 26500, Greece. gdimitriou@med.upatras.gr.
authors.forename: Gabriel
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authors.lastname: Dimitriou
authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics, Latifa Hospital, Dubai Health Authority, Government of Dubai, United Arab Emirates. kelatawi@eim.ae.
authors.forename: Khaled
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authors.lastname: El-Atawi
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. sascha.ifflaender@uniklinikum-dresden.de.
authors.forename: Sascha
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authors.affiliation: Clinic for Pediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, 23562, Lübeck, Germany. jung@paedia.ukl.mu-luebeck.de.
authors.forename: Philipp
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authors.affiliation: Clinic of Neonatology, Jessenius Faculty of Medicine Martin, Comenius University Bratislava, University Hospital in Martin, 03601, Martin, Slovakia. matasova.katarina@gmail.com.
authors.forename: Katarina
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authors.affiliation: División de Neonatología, Instituto Nacional de Perinatología, 11000, México, D.F, México. violetaojinaga@hotmail.com.
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authors.affiliation: Department of Neonatology, Kaunas University of Medicine, Kaunas, 44307, Lithuania. zitapetruskeviciene@mail.lt.
authors.forename: Zita
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authors.lastname: Petruskeviciene
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, Vest Children's Hospital Datteln, University Witten/Herdecke, 45711, Datteln, Germany. claudia.roll@uni-duisburg-essen.de.
authors.forename: Claudia
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authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, 1090, Vienna, Austria. n.staal@t-online.de.
authors.forename: Nanette
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authors.affiliation: Department of Neonatology, Children's Clinic of Tartu University Hospital, 51014, Tartu, Estonia. maie.veinla@kliinikum.ee.
authors.forename: Maie
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authors.affiliation: Division of Neonatology, University & Polytechnic Hospital La Fe, 46009, Valencia, Spain. maximovento@telefonica.net.
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authors.lastname: Zotter
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mesh_terms: D001034:Apgar Score; D003696:Delivery Rooms; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors