ArticlePediatric research2024
Combining activity and grimace scores reflects perinatal stability in infants <32 weeks gestational age.
Article in Pediatric research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Five-Minute Apgar Scores and Its Prognostic Value for Mortality and Severe Morbidity in Very Preterm Infants: A Multinational Cohort Study.BJOG : an international journal of obstetrics and gynaecology · 2026Observational
- Assessing the postnatal condition: the predictive value of single items of the Apgar score.BMC pediatrics · 2025Article
- Assessing newborn scoring with each resuscitation (ANSWER): Protocol for identifying and testing an Apgar score for the 21st century.PloS one · 2025Article
- Neuromuscular components of Apgar score in predicting delivery room respiratory support.Pediatric research · 2024Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundOver 95% of infants less than 32 weeks gestational age-very preterm infants (VPTI)-require cardiorespiratory support at birth. Clinical condition at birth is assessed by the Apgar score, but the precision and accuracy of activity and grimace has not been evaluated. We hypothesised activity and grimace could predict the level of cardiorespiratory support required for stabilisation.
methodsTwo hundred twenty-nine videos of VPTI resuscitations at Monash Children's Hospital and The Royal Women's Hospital, Melbourne were evaluated, with 78 videos eligible for assessment. Activity and grimace were scored (0, 1, or 2) by seven consultant neonatologists, with inter-rater reliability assessed. Activity and grimace were correlated with the maximum level of cardiorespiratory support required for stabilisation.
resultsKendall's Coefficient of Concordance (W) showed strong interobserver agreement for activity (W = 0.644, p < 0.001) and grimace (W = 0.722, p < 0.001). Neither activity nor grimace independently predicted the level of cardiorespiratory support required. Combining activity and grimace showed non-vigorous infants (combined score <2) received more cardiorespiratory support than vigorous (combined score ≥ 2).
conclusionScoring of activity and grimace was consistent between clinicians. Independently, activity and grimace did not correlate with perinatal stabilisation. Combined scoring showed non-vigorous infants had greater resuscitation requirements. IMPACT: Our study evaluates the precision and accuracy of activity and grimace to predict perinatal stability, which has not been validated in infants <32 weeks gestational age. We found strong score agreement between assessors, indicating video review is a practical and precise method for grading of activity and grimace. Combined scoring to allow a dichotomous evaluation of infants as non-vigorous or vigorous showed the former group required greater cardiorespiratory support at birth.
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