Use of the expanded Apgar score for the assessment of intraventricular and intraparenchymal haemorrhage risk in neonates

Objectives: Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates. Material and methods: Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw. Results: Gestational age was the most relevant discriminating variable for the prediction of intraventricular III degree and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score <= 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively. Conclusions: Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS.