Predictive Ability of Conventional and Combined Apgar Scores versus Neonatal Resuscitation and Adaptation Score in Early Neonatal Assessment

Abstract

Objective: The aim of this study was to assess the Neonatal Resuscitation and Adaptation Score (NRAS) value compared to the conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Design: A prospective cohort study was conducted on 289 neonates delivered at Menoufia University Hospitals. Trained physicians measured conventional Apgar score, combined Apgar score, and NRAS for the neonates at 1 and 5 minutes after delivery in the delivery room. Admitted neonates were followed during their stay to detect any adverse outcomes. Results: Morbidities such as the need for neonatal intensive care (NICU) admission, mechanical ventilation, surfactant & inotropes administration, need for extensive phototherapy ,intravenous immunoglobulin or exchange transfusion, anemia, metabolic acidosis, abnormal liver and kidney function tests, coagulopathies, hypoglycemia, development of seizures in the 1st 72 hours of life and positive changes in cranial ultrasound were significantly higher in neonates who lie within low or moderate NRAS than conventional and Combined Apgar scores (p<0.05). As predictors of mortality, the low and moderate values of the NRAS had higher positive predictive values at 1 minute (73.91% and 30.61%) and 5 minutes (88.89% and 50.94%) than the conventional Apgar scores at 1 minute (49.18% and 20.53%), 5 minutes (81.25% and 41.27%), the combined Apgar scores at 1 minute (35.63% and 12.45%) and 5 minutes (53.1% and 41.33%). Conclusion: Our study suggests that the NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Furthermore, a depressed 5-minutes NRAS is more predictive of mortality than1-minute score.