The relationship between the five minute Apgar score,mode of birth and neonatal outcomes

Objective: To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes.

Methods: This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers’ Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories – low (0–3), intermediate (4–6), and normal (≥7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group.

Results: The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (≥7) Apgar score, 439 (1.1%) had an intermediate score (4–6) and 114 (0.3%) had a low (0–3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes.

Conclusions: Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes.     

A comparative study of low 5-minute Apgar scores (<8) in newborns of wanted versus unwanted pregnancies in southern Tehran,Iran (2006–2007)

Objective. To compare 5-minute Apgar scores in newborns of wanted versus unwanted pregnancies.

Methods. This longitudinal cohort study included 1800 pregnant women attending urban and rural health centres in southern Tehran for routine prenatal care. The subjects were divided into two equal groups as wanted and unwanted pregnancies and were followed up through their prenatal care to their delivery. Low Apgar was defined as a score of < 8. Various conditions thought to increase the risk of low Apgar were assessed by logistic regression.

Results. We found a prevalence of 0.4% (4 cases) for low 5′ Apgar in wanted pregnancies and 1.7% (15 cases) in unwanted pregnancies. The difference between the two groups was significant (P value = 0.01). In logistic regression analysis, unwanted pregnancy status had a strong independent relationship with low Apgar, increasing the risk by 3-fold. The attributable risk in unwanted pregnancies was 0.54 (CI_0.95 = 0.13–0.81).

Conclusions. In addition to the well-established maternal complications of unwanted pregnancy (e.g. emotional stress, illegal abortions, etc) it becomes clear that such pregnancies endanger the infant's health too. It is possible that many pregnant women, especially those with unwanted pregnancies, are not attending health centres for prenatal care. Further studies with active case finding are recommended to confirm these findings.     

Sensorineural hearing loss in children: The association with Apgar score. A registry-based study of 392 371 children in Norway

ObjectivesThe causes of congenital permanent hearing loss in children are insufficiently understood. We studied the association of Apgar score 5 min after birth with sensorineural hearing loss diagnosed before the age of 5 years.MethodsWe performed an epidemiological cohort study with data obtained by linkage between The Medical Birth Registry of Norway and the Norwegian County Registry of Children with Hearing Loss. Cases were 327 children born in Norway during the period 1978–1998 with sensorineural hearing loss. Controls were all children in Norway without sensorineural hearing loss born in the same counties and during the same period as the cases (n = 392 044). The associations of Apgar score 5 min after birth with sensorineural hearing loss were estimated as odds ratios (OR) with 95% confidence intervals (CI) by applying logistic regression analyses.ResultsAmong children with sensorineural hearing loss 0.9% (3/327) had Apgar score <3, whereas that was true for 0.1% (304/392 044) of children without hearing loss (p = 0.001, chi square test). The aOR for sensorineural hearing loss was 7.5 [95% CI 2.3–, 24.2] comparing Apgar score <3 to Apgar score 10, after adjustment for birthweight and concurrent birth defects. Most children with sensorineural hearing loss (90%) had Apgar score >8 five minutes after birth.ConclusionsLow Apgar score was associated with childhood sensorineural hearing loss. However, most children with sensorineural hearing loss, had Apgar score >8.     

Target decision to delivery intervals for emergency caesarean section based on neonatal outcomes and three year follow-up

Objective

To investigate current target decision to delivery intervals (DDIs) for ‘emergency’ caesarean section.

Study design

Prospective observational cohort study in a teaching hospital providing district and tertiary maternity services delivering 6000 babies per annum.

Results

68% Category 1 deliveries were achieved within 30 min and 66% Category 2 within 75 min (26% for antepartum Category 2 deliveries). Category 1 deliveries were quicker using general rather than regional anaesthesia (21 vs. 29 min, odds ratio [OR] for delivery <30 min 4.2, 95%CI 1.3–14.2). 8% Category 1 and 4% Category 2 neonates were acidotic or asphyxiated. The risk of acidosis was not reduced by delivery within 30 min for Category 1 (OR 0.56; 0.11–2.81), or within 75 min for Category 2 (OR 2.72; 0.6–25.1). Three babies were registered with developmental impairment by three years of age; none were Category 1 deliveries.

Conclusions

Our data suggest that clinical triage is effective, with the more compromised fetus delivered more rapidly using general anaesthesia. For Category 1 deliveries a 30 min target DDI is appropriate, although those born after longer DDI did not show developmental impairment. For Category 2 caesarean sections performed for acute fetal distress or concerns, failed instrumental delivery, failure to progress or placental bleeding, a 75 min DDI may be an appropriate target but did not protect against acidosis, asphyxia or developmental impairment. Longer DDIs did not result in unfavourable outcomes for other Category 2 indications.     

孤立性单脐动脉新生儿78例临床分析

目的 探讨孤立性单脐动脉（isolated single umbilical artery,ISUA）新生儿出生时的健康情况.方法 2006年1月至2012年12月于我院出生的ISUA新生儿78例为ISUA组,同期于我院出生的脐带发育正常新生儿78例为对照组,回顾性分析两组新生儿出生后的Apgar评分、出生体重、转入新生儿重症监护室发生率、新生儿脐动脉血pH值及新生儿母亲产前进行羊膜腔穿刺进行染色体检查情况.结果 ISUA组新生儿体重（3246±75）g,低于对照组（3565±58）g,差异有统计学意义（P＜0.05）,而两组新生儿的出生后Apgar评分、转入新生儿重症监护室的发生率、新生儿脐动脉血pH值的差异均没有统计学意义（P＞0.05）.ISUA组新生儿母亲产前26例行羊膜腔穿刺,对照组仅l例,胎儿染色体检查均正常.结论 ISUA新生儿出生时与正常新生儿相比健康状况无明显差异,不需特别监护.     

非头先露早产胎膜早破42例妊娠结局

目的探讨非头先露早产胎膜早破（preterm premature rupture of membranes,PPROM）的并发症、分娩方式及母婴结局。方法回顾性分析在北京航天总医院分娩的42例非头先露PPROM和178例头先露PPROM的临床资料,对两组并发症、分娩方式及母儿结局进行比较。结果非头先露PPROM在脐带脱垂、羊水过少、1min低Apgar评分、死胎死产、新生儿死亡的发生率显著高于对照组,差异有统计学意义（P值分别为〈0.001、〈0.001、〈0.001、〈0.035、〈0.001）。非头先露PPROM组剖宫产率明显高于对照组（P〈0.001）;采取多因素Logistic回归分析,非头先露PPROM组脐带脱垂（P=0.021,OR=0.073）,1min低Ap-gar评分（P=0.018,OR=0.092）的发生率显著增高,PPROM组脐带脱垂的发生率明显高于同期足月PROM组（4.1%vs0.5%）,且同期非头先露PROM组脐带脱垂的发生率明显高于同期头先露PROM组（2.6%vs0.5%）,差异有高度统计学意义（P〈0.001）。结论非头先露PPROM是脐带脱垂、1min低Apgar评分的危险因素,剖宫产是非头先露PPROM较为安全的分娩方式,如阴道分娩需提高臀位助产技术。     

Biochemical and clinical predictors of hypoxic–ischemic encephalopathy after perinatal asphyxia

Objective: To determine the usefulness of measures, available shortly after birth, as predictors of hypoxic–ischemic encephalopathy (HIE) following perinatal asphyxia.

Patients: All inborn patients at Southmead Hospital between January 2012 and March 2014 at ≥36 weeks gestation with a pH <7 or BE >16 on cord or baby’s blood within one hour of birth or 10-minute Apgar score ≤5 or requiring intermittent positive pressure ventilation at 10?minutes were eligible for inclusion.

Methods: ROC curves were derived for the perinatal clinical and biochemical measures to establish their predictive values for the development of HIE and the area under the curve (AUC) used as the measure of prediction.

Results: We identified 79 eligible babies. Infants qualifying for therapeutic hypothermia (TH) based on aEEG abnormalities were considered to have HIE (n?=?13; 16.5%), whereas babies with normal aEEG were classified as “non-HIE” (n?=?66; 83.5%). The highest AUC measure was associated with the five-minute Apgar score (0.89 (0.79–0.99)). Troponin T (0.81 (0.64–0.98)) and ALT (0.78 (0.60–96)) also showed high values.

Conclusions: In this work, the Apgar score, troponin T and ALT were found to be strong and useful predictors of HIE.     

Predictive value of fetal scalp pH and base excess for fetal acidosis and poor neonatal outcome

Objective: The objective of this study is to assess retrospectively the predictive value of fetal scalp pH and base excess (BE) for fetal acidosis and poor neonatal outcome in term, low-risk, spontaneous deliveries with suspicious or pathological intrapartum cardiotocography (CTG) tracings.

Methods: Umbilical artery pH and BE values obtained immediately after delivery and Apgar score were the outcomes under consideration. Statistics included receiver-operating characteristic curve (ROC) and multiple logistic regression analysis.

Results: Four hundred and six deliveries were included in the study. Scalp pH?p?Apgar score?≤?7 at 5?min with 61.9% sensitivity and 91.7% specificity (p?Apgar score, independently of intrapartum pH values.

Conclusion: Our study supports the consideration of both scalp pH and BE values, when fetal blood sampling (FBS) is used.     

脐动脉血气分析和 Apgar评分评估新生儿窒息的临床探讨

目的探讨脐动脉血气分析及Apgar评分在评估新生儿窒息中的临床意义。方法选择2012年3月～2013年3月广东省肇庆市第二人民医院分娩的84例新生儿作为研究对象,其中34例窒息新生儿为观察组．50例正常新生儿为对照组。分析两组新生儿出生时Apgar评分及脐动脉血血气分析与脏器损伤的关系,脐动脉血pH值与出生1minApgar评分的关系。结果观察组中,pH值〈7．2者占38．2％,对照组中pH值〈7．2者占16．0％,脐动脉血pH值较低的患儿,Apgar评分也较低,同时窒息的发生率较高,差异均有统计学意义（P〈0．05）。结论评估新生儿窒息不能没有血气分析的结果,脐动脉血气分析比Apgar评分对评估新生儿窒息更具客观性,两者结合,能反映胎儿宫内缺氧缺血程度,为临床正确及时诊断新生儿窒息提供可靠的科学依据。