Antecedents and neonatal consequences of low Apgar scores in preterm newborns: a population study

BACKGROUND: To examine the antenatal and early neonatal correlates of low Apgar scores (<3 and <6 at 1 and 5 minutes) in preterm newborns (23-34 weeks' gestation). OBJECTIVE: The use of Apgar scoring for premature newborns remains widespread, despite controversy regarding its reliability as a measure of morbidity and mortality in the neonatal period. DESIGN: A cohort of 852 preterm newborns born during a 34-month period between 1984 and 1987 was studied. Newborns were stratified into 2 groups by gestational age (23-28 weeks and 29-34 weeks), and data were analyzed, controlling for gestational age in single weeks. SETTING: Two academic and 1 community hospital, which together accounted for 83% of all preterm births in a tri-county area of central New Jersey during the study period. PATIENTS: All premature newborns (birth weight <2000 g and gestational age <35 weeks) born in the participating hospitals during the study period were evaluated. MAIN OUTCOME MEASURES: Antecedents included maternal illness during pregnancy, maternal complications of labor and delivery, and fetal heart rate abnormalities during labor and delivery. Consequences included delivery room resuscitation, abnormal physical findings, diagnoses, and therapeutic interventions in the first 6 to 8 hours of life. RESULTS: Premature newborns with low Apgar scores received more cardiopulmonary resuscitation in the delivery room and in the first 6 to 8 hours of neonatal intensive care. Mortality was significantly increased among newborns with low Apgar scores (54% vs. 26% in the 23- to 28-week stratum, 30% vs 6% in the 29- to 34-week stratum). Newborns with low Apgar scores in the 29- to 34-week stratum more often required intubation, positive pressure ventilation, and umbilical vessel catheterization. Newborns with low Apgar scores had higher rates of bradycardia, pneumothoraces, acidosis, and increased oxygen requirement during the first 6 to 8 hours of life. Maternal illness, complications of labor and delivery;, and fetal heart rate decelerations did not correlate with subsequent Apgar scores of newborns. The presence of severe bradycardia (<90/min) and fetal heart rate accelerations correlated with low Apgar scores in the 29- to 34-week group. CONCLUSION: Low Apgar scores are associated with increased neonatal morbidity and mortality in preterm newborns. Antenatal maternal history, and pregnancy complications are not clearly associated with low Apgar scores. Therefore, the Apgar score is a useful tool in assessing neonatal short-term prognosis and the need for intensive care among preterm newborns.     

极低/超低出生体重儿生后1 min低Apgar评分的危险因素：多中心回顾性研究

目的 探讨极低/超低出生体重儿生后1 min低Apgar评分(≤7分)的危险因素。方法 回顾性收集2018年1月—2019年12月江苏省新生儿重症监护病房母乳喂养质量改进临床研究协作组多中心临床数据库极低/超低出生体重儿的临床资料。按生后1 min Apgar评分分为低Apgar评分组(Apgar评分≤7分)和正常Apgar评分组(Apgar评分>7分)。采用多因素logistic回归分析法探讨生后1 min低Apgar评分的影响因素。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析评价相关指标对生后1 min低Apgar评分的预测价值。结果 纳入1 809例极低/超低出生体重儿。1 min低Apgar评分发生率为52.90%(957/1 809)。多因素logistic回归分析显示:胎龄越大,患儿出现1 min低Apgar评分的风险越小(OR=0.853,P<0.05);出生体重越大,患儿出现1 min低Apgar评分的风险越小(OR=0.999,P<0.05);羊水异常的患儿出现1 min低A...     

Visual function at school age in children with neonatal encephalopathy and low Apgar scores

OBJECTIVE: To assess different aspects of visual function at school age in children who suffered from neonatal encephalopathy. METHOD: Thirty nine full term infants with neonatal encephalopathy, low Apgar scores, and early neonatal imaging were studied using a battery of tests assessing different aspects of visual function (crowding acuity, stereopsis, visual fields) at school age. The results were compared with brain magnetic resonance imaging (MRI) findings and, when possible, with the results of the assessment of visual function performed at 5 and 12 months, available in 24 of the 39 children examined at school age. RESULTS: Sixteen of the 39 children (41%) had abnormal results at school age in at least one of the visual tests used. Seven of these 16 were untestable on all tests. The remaining 23 children (59%) had normal results. CONCLUSIONS: The presence and severity of visual impairment was related to the severity of brain lesions. Moderate or severe basal ganglia lesions and severe white matter changes were always associated with abnormal visual function. Infants with normal MRI, minimal basal ganglia lesions, and minimal or moderate white matter involvement tended to have normal vision. It was also found that the assessment of visual function performed in the first year was a reliable indicator of visual function at school age. With two exceptions, the results on the 5 month visual assessment were predictive of visual outcome at school age. In the remaining two cases, a normal visual outcome at 5 years was associated with visual abnormalities at 5 months but these had already normalised by the age of 1 year.     

Mortality and immediate morbidity in term babies with low Apgar scores (Zimbabwe).

A retrospective study was undertaken to document immediate morbidity and mortality associated with low Apgar scores (5 or less) at 5 min in singleton term babies (37 weeks or more). From October 1986 to February 1987, 84 term babies had low Apgar scores, giving an incidence of 15/1000 live births. Overall mortality in these patients was 42%, and in those in whom Apgar scores remained 0-3 at 5 min, mortality was 77%. Evidence of severe-to-moderate hypoxic-ischaemic encephalopathy was noted in 44 (52%) and 17 (20%) failed to establish spontaneous respiration within the 1st few hours of life. Meconium aspiration syndrome was diagnosed in 29 (35%). A control group of 141 term babies with 5-min Apgar scores of 7 or more were identified and the presence of possible risk factors associated with low Apgar scores was assessed. Primiparity and prolonged second stages of labour in all parities were found to be significantly associated with low Apgar scores. Improved obstetric care and appropriate management of the newborn at delivery and in the neonatal period may help to reduce mortality and morbidity in some term babies.     

Investigation of the relationship between low Apgar scores and early neonatal thyroid function

BACKGROUND: The aim of the present study was to assess the effects of low Apgar scores on perinatal thyroid function. METHODS: Forty full-term infants delivered by the normal spontaneous vaginal route were enrolled into the study. All babies had 1 and 5 min Apgar scores below 4. The control group consisted of 26 full-term healthy neonates. Cord blood and serum tri-iodothyronine (T3), thyroxine (T4), reverse tri-iodothyronine (rT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH) and thyroid-binding globulin (TBG) determinations were performed by an enzyme immunoassay method. RESULTS: The mean values of FT4 and T4 observed in the cord blood of the study group were significantly lower compared with matched controls, whereas the mean TSH values were significantly higher. There were no differences in concentrations of T3, rT3 and TBG between the two groups. CONCLUSIONS: These results demonstrate the existence of transient hypothyroidism at birth in babies with Apgar scores below 4 delivered by the spontaneous vaginal route.     

Cochlear function in 1-year-old term infants born with hypoxia-ischaemia or low Apgar scores

Aim: To examine the influence of perinatal hypoxia‐ischaemia (HI) or low Apgar scores on distortion product otoacoustic emissions (DPOAEs) in infants at 1 year and detect any postnatal changes. Methods: Eighty‐eight term infants born with perinatal HI or low Apgar scores alone were recruited at 1 year of age. The ears with type A tympanogram (normal) were studied with DPOAEs at 10 frequencies between 0.5 kHz and 10 kHz. Results: DPOAE pass rates were decreased at all frequencies 1–10 kHz, particularly 1 and 2 kHz in both infants born with HI and those with low Apgar scores (χ²= 3.80–15.09, P < 0.05–0.01). Overall pass rates in the two groups were also decreased (X²= 10.78 and 12.12, P < 0.01 and 0.01). No marked differences were found between infants born with HI and those with low Apgar score. Compared with those recorded at 1 and 6 months, DPOAE pass rates at 1 year were increased slightly in infants born with HI, but showed no marked changes in those born with low Apgar scores. Conclusions: DPOAE pass rates, mainly at 1 and 2 kHz, were decreased at 1 year in infants born with perinatal HI and low Apgar scores, suggesting a relative poor cochlear function. Further studies are needed to ascertain the hearing acuity.     

Effects of familial risk factors and place of birth on the risk of autism: a nationwide register-based study

BACKGROUND: The etiology of autism is unknown. A strong genetic component has been detected but non-genetic factors may also be involved in the etiology. METHODS: We used data from the Danish Psychiatric Central Register and the Danish Civil Registration System to study some risk factors of autism, including place of birth, parental place of birth, parental age, family history of psychiatric disorders, and paternal identity. RESULTS: A total of 943,664 children younger than ten years were followed from 1994 to 2001; of those, 818 children developed autism. The highest risks of autism were found in siblings of children with autism, or Asperger's syndrome and other pervasive developmental disorders (PDDs), with relative risks of 22 and 13, respectively. The relative risk of autism in the child was about twice as high if the mother had been diagnosed with a psychiatric disorder. The risk of autism was associated with increasing degree of urbanisation of the child's place of birth and with increasing paternal, but not maternal, age. An increased relative risk of 1.4 was found if the mother was born outside Europe, and in children of parents who were born in different countries. CONCLUSIONS: The highest risk of autism was found in families with a history of autism, or Asperger's syndrome and other PDDs in siblings, supporting the commonly accepted knowledge that genetic factors are involved in the etiology of autism.     

Risk of low Apgar score and socioeconomic position: a study of Swedish male births

AIM: The aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of < 7 at 1 and 5 min following birth). METHODS: The research is based on a population cohort study of 183,637 males born in Sweden between 1973 and 1976. Data from the Medical Birth Register were linked to Population and Housing Censuses. RESULTS: There was evidence that mothers working in non-manual (Odds ratio (OR) 0.83 (0.72-0.97)) and self-employed (OR 0.64 (0.44-0.93)) occupations were less likely to have an infant with a low Apgar score, compared to manual workers. There was evidence that the risk of a low Apgar score decreased as the mother's level of education increased, if the infant was born by instrumental (OR 0.86 (0.74-0.99)) or caesarean section (OR 0.80 (0.68-0.93)) delivery, but not by unassisted vaginal delivery (OR 1.01 (0.92-1.10)). CONCLUSION: There was a lower risk of poor birth condition in male infants born to more educated and non-manual/self-employed mothers. These differences may contribute to our understanding of socioeconomic differences in infant health and development although the results may not be applicable due to changes over the last 30 years.     

Epidemiology and risk factors of pediatric chest pain: a systematic review

The epidemiology and associated risk factors of pediatric chest pain are not well described. Several studies report the prevalence of chest pain types among children and adolescents; however, detailed prospective studies that aim to determine continued morbidity, mortality, health-care seeking behaviors, continued medication use, and quality of life are lacking. A greater understanding of pediatric chest pain epidemiology and risk factors is required.     

Neonatal risk factors and risk scores including auditory evoked responses

In a prospective study, 81 preterm infants and 25 healthy term infants were neurologically and neurophysiologically evaluated in the neonatal period. At 5–7 years of age the neurodevelopmental outcome was assessed. The validity and predictive value of the Neonatal Neurological Inventory (NNI) and the Neurobiological Risk Score (NBRS), including an additional gestational age factor (GAF) and an auditory evoked response factor (AERF) were assessed. Three of the 53 surviving preterm infants showed major neurological abnormalities at 5–7 years. Five infants showed neuropsychological abnormalities and 12 infants showed both neurological and neuropsychological abnormalities. An important subgroup of preterm infants could be identified as high-risk using the NNI and NBRS. The low sensitivity and negative predictive value resulted in a number of false-negative results. Logistic regression showed that intraventricular haemorrhage (IVH) and bilirubin levels contributed highly to the prediction of neurological outcome. For neuropsychological outcome these factors were IVH and assisted ventilation. Addition of the GAF and AERF as separate items to the NBRS did not affect the predictive power. Combined addition of the GAF and AERF showed improvement of both validity and predictive value. Conclusion This study shows that IVH, bilirubin and assisted ventilation contribute most to the validity and predictive value of the NBRS. Furthermore, regarding neurological outcome addition of a GAF in combination with an AERF resulted in a substantial improvement of the validity and predictive value. The shortcomings of the current neonatal risk scores require a careful interpretation of clinical perinatal data regarding the prediction of neurodevelopmental outcome in preterm infants. Received: 20 July 1996 and in revised form: 10 July 1997 / Accepted: 11 July 1997     

Epidemiology of vertically transmitted HIV-1 infection in Switzerland: Results of a nationwide prospective study

A nationwide study involving 286 children of human immunodeficiency virus (HIV)-infected mothers living in Switzerland has been performed with the participation of all paediatricians interested in HIV infection in the country. Of these children 201 could be followed up prospectively from birth up to a median age of 22 months. Prevalence of HIV infection in Swiss parturients was estimated at 0.1% and apparently remained stable from 1986 to 1989. Vertical transmission rate was estimated at 14%–20%. Variables of maternal or perinatal history were not associated with transmission rate. Transmission to pairs of siblings of the same mothers was discordant in 33% (6 of 18), with always the elder sibling being infected. Postneonatal mortality in infants of HIV-infected mothers followed up from birth was increased 15-fold over the general population with a very high incidence (2 in 100) of sudden infant death apparently unrelated to HIV infection.A complete list of all the participants in the study is available on request