In der prospektiven multizentrischen Studie wurde die Validität des kombinierten Apgar-Scores bei Neugeborenen mit postnataler Unterstützung untersucht. Die Studie wurde analog zur Studie 'TEST-Apgar' durchgeführt, die den kombinierten Apgar-Score an Frühgeborenen getestet hat.:Danksagung i Inhaltsverzeichnis ii Abkürzungsverzeichnis iv Abbildungs- und Tabellenverzeichnis v I. Einleitung 1 1. Perinatalmedizin 1 2. Der konventionelle Apgar-Score 1 2.1. Stärken des Apgar-Scores 2 2.1.1. Unterscheidung zwischen gutem und schlechtem postnatalem Zustand 2 2.1.2. Evaluation der Veränderung des Neugeborenen über die Zeit 4 2.1.3. Prädiktive Aussagekraft 4 2.2. Kritik am konventionellen Apgar-Score 6 2.2.1. Gewichtung der Parameter 6 2.2.2. Interindividuelle Variabilität bei der Bewertung 7 2.2.3. Bewertung von Frühgeborenen 9 2.2.4. Bewertung von beatmeten Neugeborenen 9 3. Neue Apgar-Scores zur Bewertung des postnatalen Zustands des Neugeborenen 10 3.1. Der spezifizierte Apgar-Score 11 3.2. Der erweiterte Apgar-Score 12 3.3. Der kombinierte Apgar 13 4. Fragestellung 14 II. Methoden 16 1. Studiendesign 16 2. Zustimmung durch die Ethikkommission 16 3. Auswahlkriterien des Studienkollektivs 16 3.1. Einschlusskriterien 16 3.2. Ausschlusskriterien 17 4. Verwendete Parameter 17 4.1. Daten zu Schwangerschaftsverlauf und Geburt 17 4.2. Neonatale Daten 17 4.3. Neonatale Entlassdaten 18 5. Verwendete Punktsysteme 18 6. Datenmanagement 20 7. Digitalisierung 20 8. Statistische Analyse 20 III. Ergebnisse 22 1. Deskription der Studienpopulation 22 1.1. Perinatale Charakteristika 22 1.2. Outcome Daten 23 1.3. Durchgeführte Interventionen 23 1.4. Zustandsbeschreibung 24 2. Überprüfung der Hypothese 26 2.1. Beschreibung des neonatalen Zustandes (spezifizierter Apgar-Score) 26 2.2. Beschreibung der erfolgten Intervention (erweiterter Apgar-Score) 26 2.3. Kombinierter Apgar 26 2.4. Prädiktion eines adverse outcomes 28 3. Sekundäre Fragestellungen 31 3.1. Aussagen zum Nabelschnur-pH-Wert 31 3.1.1. Zusammenhang zwischen NapH und klinischem Zustand 31 3.1.2. Zusammenhang zwischen NapH und Interventionen 31 3.1.3. Kombinierter Apgar-Score 31 4. Wechselseitige Beeinflussung von klinischem Zustand und durchgeführten Interventionen 33 IV. Diskussion 37 1. Kurzzusammenfassung der Ergebnisse 37 2. Diskussion 38 3. Ausblick 43 V. Fazit 46 VI. Zusammenfassung 47 VII. Summary 48 Literaturverzeichnis vi Anlage 1 x Anlage 2 xi

Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone. Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated. Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively. Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.

Background: Since an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone. Methods: Scores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated. Results: Of 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively. Conclusion: The Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.