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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 28 6/7  ± 2 3/7  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.    Trial registration  clinicaltrials.gov Protocol Registration System ( NCT00623038 ). Registered 14 February 2008.    Electronic supplementary material  The online version of this article (doi:10.1186/s12887-015-0334-7) contains supplementary material, which is available to authorized users.

Neonatal assessment in the delivery room – Trial to Evaluate a Specified Type of Apgar (TEST-Apgar)