Comparison of Conventional and Combined APGAR score in Predicting Adverse Early Neurologic Outcomes in Term and Near Term Babies with Birth Asphyxia

Objective: To compare the Conventional and Combined Apgar scoring systems in predicting adverse early neurologic outcomes in term and near term babies with birth asphyxia. Methods: A retrospective cross sectional study was conducted over a period of 2 years. All the neonates with gestational age more than 35 weeks delivered in this hospital with birth asphyxia requiring admission in NICU were included in the study. Neonates with gestational age less than 35 weeks, those with major congenital anomalies and death in delivery room were excluded from the study. The APGAR and COMBINED APGAR scores were noted. Convulsion, use of anticonvulsant drugs, requirement of mechanical ventilation, and duration of hospital stay were also noted. The data was analysed using fisher exact test. Results: Statistically significant associations were observed between Apgar score less than 3 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p<0.001), Apgar score less that 6 at 5 minutes” occurrence of convulsion (p=0.001) and requirement of ventilation (p<0.001), Combined Apgar score less that 7 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p=0.002), Combined Apgar score less that 10 at 5 minutes and occurrence of convulsion (p<0.001) and requirement of ventilation (p<0.001), and early neonatal death (within 7 days)” and Combined Apgar score less than 7 at 1 minute (p=0.09) and Combined Apgar score less than 10 at 5 minutes (p=0.09). Conclusion: Though a low combined apgar score was superior to the traditional apgar score in predicting early neonatal mortality, no difference was seen in prognostication of convulsion and mechanical ventilation.