Study of the Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score in Neonatal Resuscitation

Elglil, Aya Mohamed Abd; Ibrahim, Ahmed; Shihab, Nihal; Mashad, Abd El Rahman Mohamed El

doi:10.9734/jammr/2020/v32i2430757

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…Elglil et al elicited results that align with ours for low and moderate 1-minute scores but not for 5 minutes ones. 22 Nonsurvived cases within the low 1-and 5-minute and moderate 1-minute NRAS were higher than conventional and combined Apgar scores (p ¼ 0.004, 0.03, and <0.001, respectively). These findings are partially in accordance with Witcher et al, who elicited higher death rates among low 1minute NRAS versus Apgar (53 vs. 17%, p < 0.05).…”

Section: Discussionmentioning

confidence: 82%

“…14 On the other hand, Elglil et al and Chamorro et al go in line with our results in their studies. 22,23 Such observations strongly reflect the practicability of the novel NRAS and how it correlates well with an infant's actual need for further supportive measures. 12 Moderate 1-minute NRAS was significantly associated with an infant's probability of the need for an extensive session of phototherapy, administration of IVIG, or blood exchange (p ¼ 0.04), whereas no significant differences were found between the studied scores at low 1 and 5 minutes or moderate 5 minutes.…”

Section: Discussionmentioning

confidence: 92%

“…14 On the other hand, Elglil et al and Chamorro et al go in line with our results in their studies. 22 23…”

Section: Discussionmentioning

confidence: 99%

“…Elglil et al elicited results that align with ours for low and moderate 1-minute scores but not for 5 minutes ones. 22…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 92%

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

et al. 2023

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Systematic review of Apgar scores & cyanosis in Black, Asian, and ethnic minority infants

Fair,

Furness,

Higginbottom

et al. 2024

Pediatr Res

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Background Apgar score and cyanosis assessment may disadvantage darker-skinned babies. This review explored cyanosis and Apgar score assessments in Black, Asian, or minority ethnic neonates compared to White neonates. Material and methods Four databases were searched. Studies of any methodology were included. A narrative synthesis was undertaken. Results Ten studies were included. Three studies involving over 39 million neonates showed Apgar score ≤3 was predictive of neonatal mortality across all ethnicities. Black babies with Apgar score ≤3 had lower mortality rates before 28 days, however, variations in scoring practices were also observed. Three further studies (n = 39,290,014) associated low Apgar scores with poorer mental development up to 22 months, especially in mixed ethnicity and Black infants. One study reported inadequate training in assessing ethnic minority neonates. Cyanosis was the focus of three included studies (n = 455) revealing poor visual assessment of cyanosis across ethnicities. With pulse oximetry occult hypoxemia occurred slightly more frequently in Black neonates. Tongue color indicated oxygen requirement at birth, regardless of ethnicity. Conclusions Apgar scores correlate well with neonatal mortality in all ethnicities, however scoring variations exist. Cyanosis assessment is challenging, with tongue and lips the best places to observe in the absence of pulse oximetry. Impact Assessment of the color component of the Apgar score and of cyanosis visually are not accurate in babies with darker skin. Small racial differences may exist for pulse oximetry in neonates, but it is more reliable than visual assessment.

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Understanding stakeholder perspectives on Apgar score, cyanosis and identifying jaundice in ethnic minority neonates

Fair,

Furness,

Higginbottom

et al. 2024

PLoS ONE

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Objectives To explore neonatal assessments that include an element of evaluating skin colour in neonates of black, Asian and minority ethnicities, focusing on the Apgar score, presence of cyanosis and presence of jaundice. Design We employed focused ethnography involving diverse healthcare professionals (HCPs) and parents or caregivers with Black, Asian, or ethnic minority children born in the last five years. Zoom interviews were performed following a semi-structured interview guide. Ethnographic data analysis was conducted using NVivo software. Results There was a lack of consistency in how HCPs applied the Apgar scores, which also varied from textbook guidelines. The use of pink as a skin colour descriptor for ethnic minority neonates created a divide among both parents and HCPs. HCPs relied more heavily on other elements of the Apgar score or infant breathing and crying at birth to gauge infant wellness. When identifying cyanosis, HCPs depend on specific body locations for accurate assessment of oxygenation, but the limitations of visual assessment are acknowledged. For jaundice, most HCPs recognised the difficulty in identifying the colour yellow in infants with darker skin tones. HCPs focussed on yellowing of the sclera and gums and other well-being assessments to detect jaundice. Some interviewed parents noticed jaundice in their infants before HCPs but felt they were not listened to when raising concerns. HCPs acknowledged the need for additional training to effectively assess the health of ethnic minority infants. Conclusion This study highlights disparities in neonatal health assessment from the perspectives of healthcare professionals and parents from diverse backgrounds. Varied practices in determining the Apgar score and recognising cyanosis and jaundice signal the need for standardised protocols, appropriate educational materials, and targeted training. Addressing these challenges is vital for equitable care, emphasising comprehensive training and bias mitigation efforts in maternal and neonatal healthcare.

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Study of the Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score in Neonatal Resuscitation

Cited by 3 publications

References 10 publications

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

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

Systematic review of Apgar scores & cyanosis in Black, Asian, and ethnic minority infants

Understanding stakeholder perspectives on Apgar score, cyanosis and identifying jaundice in ethnic minority neonates

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