Intravenously administered epinephrine is indicated if the heart heart rate, respiratory efort, muscle tone, relex irritability, andrate remains ;60 bpm after adequate ventilation and chest color-is assessed and assigned a value of 0, 1, or 2. In the curcompressions. The recommended intravenous dose is 0.01 to rently recommended expanded form, concurrent resuscitation 0.03 mg/kg. Epinephrine may be given through the endotracheal interventions are also recorded over time. he total score, based on tube if venous access has not been established, but its action is the sum of the five components, is determined in all neonates at 1less reliable (Kapadia, 2017). If given through the endotracheal and 5 minutes ater delivery. In those with a score <7, the scoretube, higher doses are employed-0.05 to 0.1 mg/kg.
may be calculated at urther 5-minute intervals until a 20-minute Discontinuation of Resuscitation Apgar score is assigned or resuscitation eforts are halted.
In an analysis of more than 150,000 newborns delivered at ILCOR concludes that it is reasonable to discontinue resusciParkland Hospital, Casey and associates (2001 b) assessed thetative eforts for a neonate who remains without a heartbeat signiicance of the 5-minute score for predicting survival durdespite at least 10 minutes of continuous and adequate resusciing the first 28 days of life. They found that in term neonates,tative eforts. Notably, the decision to continue or discontinue the risk of neonatal death was approximately 1 in 5000 for resuscitative eforts must be individualized (Perlman, 2015).
those with Apgar scores of 7 to 10. his risk compares with a mortality rate of 25 percent for term newborns with 5-minute scores ;3. Low 5-minute scores were comparably predictive of neonatal death in preterm neonates. These investigators con • Apgar Score cluded that the Apgar scoring system remains relevant for the he scoring system described by Dr. Virginia Apgar in 1953 prediction of neonatal survival. remains a useul clinical tool to classiY newborn health immeThere have been attempts to use Apgar scores to define diately after birth and to assess the efectiveness of resuscitative asphxial injury and to predict subsequent neurological
TABLE 32-2. 20-Minute Expanded Apgar Score
Respiration Absent Weak cry; hypo-Good, crying
Comments: Resuscitation
CPAP = continuous positive airway pressure; En = endotracheal tube; PPV = positive-pressure ventilation. Data from Weiner, 2016.
outcome-uses for which the Apgar score was never intended (Chap. 33, p. 624). Such associations are diicult to mea sure with reliability given that both asphyxial injury and low
Apgar scores are infrequent outcomes. For example, according to United States birth certiicate records for 2010, only 1.8 percent of newborns had a 5-minute score below 7 (Martin, 2012). Similarly, in a population-based study of more than 1 million term newborns in Sweden between 1988 and 1997, the incidence of 5-minute Apgar scores of �3 approximated 2 per 1000 (Thorngren-Jerneck, 2001).