@newmummycwharf1
“It is possible that you are more learned on the topic than the vast number of Professors of neonatology and Obs &Gynae involved in conducting the systematic reviews used to inform this policy paper:
https://www.nhsrho.org/research/review-of-neonatal-assessment-and-practice-in-black-asian-and-minority-ethnic-newborns-exploring-the-apgar-score-the-detection-of-cyanosis-and-jaundice/
”
I doubt it. I’d prefer it if you posted without sarcasm because it makes it difficult to follow your argument.
“It is also possible that you are aware that systematic reviews/meta-analysis are a higher level than randomised controlled trials - so the highest level of evidence”
The section of the report comprising a systematic review of studies of APGAR testing in newborns of differing ethnicities only includes six studies, but some of those are really big studies so: good data. What it shows is that a low APGAR score is more likely to be associated with infant mortality for (racialised) white newborn infants compared with (racialised) black newborn infants. However, the association is still there for all infants, “The impact of the Apgar score on neonatal mortality was considered in two large, linked birth-death datasets. The first (Mihoko Doyle et al., 2003) included 6,544,004 infants and the second (Li et al., 2013) included 25,936,357 infants. Both studies found that low Apgar score is predictive of neonatal death across different ethnicities.” (p30 of your linked report).
“If the positive predictive value of a screening tool is lower for a group of people - it is not fit for purpose for that group and needs updating. To most people - that goes without saying. The point is to improve the screening tests to the rate of detection is improve for all babies it is applied and intervention introduced early to prevent negative outcomes including death.”
I thinks it’s dishonest of you to add “including death” at the end of your paragraph. The negative outcomes for BAME newborns are all to do with over-assessment and over-treatment, there is no increased risk of infant mortality for BAME newborns associated with routine APGAR testing.
And I’m not sure that I agree this makes APGAR testing unfit for purpose. If APGAR testing were generating false negatives for BAME newborns I hope it would have been abandoned long ago. I don’t think it’s as clear cut for false positives. One policy and procedure change suggested in your linked report is that all newborn infants (or maybe just BAME newborn infants, I can’t actually tell from the way it’s written) have their blood oxygen levels assessed via use of a pulse oxymeter. This is an objective screen with no regard for skin colour, but it also involves pressing the oxymeter around the infant’s big toe, and it brings another piece of medical paraphernalia into the birthing suite, another beeping machine. There is a big push from birthing mums to only bring in the beeping machines when they’re absolutely needed at the time of birth, and the nice thing about the APGAR screen is that it just involves a midwife looking at bub – which she’s likely to be doing with joy and affection anyway.
Maybe the issue is whether you think midwives don’t give the “well perfused” APGAR point to BAME newborns because they’re racist, or if it’s because it’s harder to tell, looking at a newborn infant with dark skin, that said skin is well perfused. Maybe it’s better to hand the assessment over to the machines, which are thoroughly objective. But I think that’s a moot point (and I don’t think it’s necessary).
“Again - hope that helps.”
This sounds passive-agressive and snarky but I’m not sure what you’re being snarky about.