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PLoS Medicine Jul 2022Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations....
BACKGROUND
Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations. Given the majority of the global population is not white, we aim to assess whether the association between low Apgar score and mortality in infants varies across racial groups.
METHODS AND FINDINGS
Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data. The study included singleton infants born between 37+0 and 44+6 weeks to mothers over 15 years, without congenital abnormalities. We looked at 3 different mortality outcomes: (1) early neonatal mortality; (2) overall neonatal mortality; and (3) infant mortality. We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and smoking status, and stratified these models by maternal race group (as self-reported on birth certificates). The cohort consisted of 6,809,653 infants (52.8% non-Hispanic white, 23.7% Hispanic, 13.8% non-Hispanic black, 6.6% non-Hispanic Asian, and 3.1% non-Hispanic other). A total of 6,728,829 (98.8%) infants had normal scores, 63,467 (0.9%) had intermediate scores, and 17,357 (0.3%) had low Apgar scores. Compared to infants with normal scores, low-scoring infants had increased odds of infant mortality. There was strong evidence that this association varied by race (p < 0.001) with adjusted odds ratios (AORs) of 54.4 (95% confidence interval [CI] 49.9 to 59.4) in non-Hispanic white, 70.02 (95% CI 60.8 to 80.7) in Hispanic, 23.3 (95% CI 20.3 to 26.8) in non-Hispanic black, 100.4 (95% CI 74.5 to 135.4) in non-Hispanic Asian, and 26.8 (95% CI 19.8 to 36.3) in non-Hispanic other infants. The main limitation was missing data for some variables, due to using routinely collected data.
CONCLUSIONS
The association between Apgar scores and mortality varies across racial groups. Low Apgar scores are associated with mortality across racial groups captured by United States (US) records, but are worse at discriminating infants at risk of mortality for black and non-Hispanic non-Asian infants than for white infants. Apgar scores are useful clinical indicators and epidemiological tools; caution is required regarding racial differences in their applicability.
Topics: Apgar Score; Cohort Studies; Female; Hispanic or Latino; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; United States
PubMed: 35819949
DOI: 10.1371/journal.pmed.1004040 -
Scientific Reports Jan 2021Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of...
Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0-10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7-10 and 0-4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0-2, 3-4, and 5-6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.
Topics: Adult; Aged; Aged, 80 and over; Apgar Score; Female; Hospitalization; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Postoperative Complications; Postoperative Period; Retrospective Studies
PubMed: 33420227
DOI: 10.1038/s41598-020-80393-z -
Acta Obstetricia Et Gynecologica... Apr 2022The aim of the study was to identify the obstetric risk factors for hypoxic-ischemic encephalopathy (HIE) in infants with asphyxia at birth.
INTRODUCTION
The aim of the study was to identify the obstetric risk factors for hypoxic-ischemic encephalopathy (HIE) in infants with asphyxia at birth.
MATERIAL AND METHODS
This multicenter case-control study covered the 5-year period from 2014 through 2018 and included newborns ≥36 weeks of gestation with an umbilical pH at birth ≤7.0. Cases were newborns who developed moderate or severe HIE; they were matched with controls with pH ≤7.0 at birth over the same period without moderate or severe HIE. The factors studied were maternal, gestational, intrapartum, delivery-related, and neonatal characteristics. A multivariable analysis was performed to study the maternal, obstetric, and neonatal factors independently associated with moderate or severe HIE.
RESULTS
Our review of the records identified 41 cases and 98 controls. Compared with controls, children with moderate or severe HIE had a lower 5-min Apgar score, lower umbilical artery pH, and higher cord lactate levels at birth and at 1 h of life. Obstetric factors associated with moderate or severe HIE were the occurrence of an acute event (adjusted odds ratio [aOR] 6.4; 95% confidence interval [CI] 1.8-22.5), maternal fever (aOR 3.5; 95% CI 1.0-11.9), and thick meconium during labor (aOR 2.9; 95% CI 1.0-8.6).
CONCLUSIONS
HIE is associated with a lower 5-min Apgar score and with the severity of acidosis at birth and at 1 h of life. In newborns with a pH <7.0 at birth, the occurrence of an acute obstetric event, maternal fever, and thick meconium are independent factors associated with moderate or severe HIE.
Topics: Acidosis; Apgar Score; Asphyxia Neonatorum; Case-Control Studies; Child; Female; Humans; Hypoxia-Ischemia, Brain; Infant; Infant, Newborn; Pregnancy; Risk Factors
PubMed: 35338480
DOI: 10.1111/aogs.14326 -
Archives of Gynecology and Obstetrics Jun 2021Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk...
PURPOSE
Numbers of planned cesarean deliveries are increasing in twin pregnancies, despite the lack of evidence for this approach, and the second twin is thought to be at risk for a poorer outcome. The aim of this study was to examine whether twins have a poorer outcome if an attempted vaginal delivery is changed to a cesarean section or combined delivery.
METHODS
This retrospective data analysis included all women with dichorionic twin pregnancies attempting vaginal delivery over a 10-year period. Outcome parameters for the first and second twins relative to their mode of birth were compared. A correlation model between the interdelivery time interval and Apgar scores was calculated. Subgroup analyses assessing the birth mode of the first and second twins were conducted.
RESULTS
A total of 248 women were enrolled in the study. The second twins had significantly lower values for outcome parameters, such as umbilical artery cord pH and Apgar scores in comparison with the first twins (P < 0.01). The subgroup analysis of birth modes in first and second twins showed a significantly poorer outcome in the cesarean section and combined delivery group (P < 0.05). The interdelivery time interval was significantly longer in the second twin cesarean section group (P < 0.01). There was no significant correlation between the interdelivery time intervals and Apgar scores (P > 0.05).
CONCLUSION
Although outcome parameters were significantly lower in second twins and twins born via secondary cesarean section, the clinical relevance of this appears to be negligible.
Topics: Apgar Score; Austria; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Pregnancy, Twin; Retrospective Studies; Risk Factors; Twins
PubMed: 33222039
DOI: 10.1007/s00404-020-05882-y -
BMC Pregnancy and Childbirth Apr 2022Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate...
Prediction of low Apgar score at five minutes following labor induction intervention in vaginal deliveries: machine learning approach for imbalanced data at a tertiary hospital in North Tanzania.
BACKGROUND
Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective.
METHODS
We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (< 7) Apgar score neonates. The 'extra-tree classifier' was used to assess features' importance. We used Area Under Curve (AUC), recall, precision, F-score, Matthews Correlation Coefficient (MCC), balanced accuracy (BA), bookmaker informedness (BM), and markedness (MK) to evaluate the performance of the selected six (6) machine learning classifiers. To address class imbalances, we examined three widely used resampling techniques: the Synthetic Minority Oversampling Technique (SMOTE) and Random Oversampling Examples (ROS) and Random undersampling techniques (RUS). We applied Decision Curve Analysis (DCA) to evaluate the net benefit of the selected classifiers.
RESULTS
Birth weight, maternal age, and gestational age were found to be important predictors for the low Apgar score following induced vaginal delivery. SMOTE, ROS and and RUS techniques were more effective at improving "recalls" among other metrics in all the models under investigation. A slight improvement was observed in the F1 score, BA, and BM. DCA revealed potential benefits of applying Boosting method for predicting low Apgar scores among the tested models.
CONCLUSION
There is an opportunity for more algorithms to be tested to come up with theoretical guidance on more effective rebalancing techniques suitable for this particular imbalanced ratio. Future research should prioritize a debate on which performance indicators to look up to when dealing with imbalanced or skewed data.
Topics: Apgar Score; Delivery, Obstetric; Female; Humans; Infant, Newborn; Labor, Induced; Machine Learning; Pregnancy; Tanzania; Tertiary Care Centers
PubMed: 35365129
DOI: 10.1186/s12884-022-04534-0 -
BMC Pregnancy and Childbirth Aug 2016Intrauterine growth restriction (IUGR) is associated with perinatal morbidity and mortality. Several clinical trials have reported L-arginine and sildenafil citrate had... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intrauterine growth restriction (IUGR) is associated with perinatal morbidity and mortality. Several clinical trials have reported L-arginine and sildenafil citrate had effect on intrauterine growth restriction fetuses. A meta-analysis of available randomized controlled trials (RCTs) was conducted to investigate the effects of L-arginine and sildenafil citrate on major clinical outcomes of IUGR fetuses.
METHODS
Systematically searched Medline, Embase, the Cochrane Library, and Clinical Trials, references of retrieved articles, and conference proceedings from 1960 to 2015. We included randomized controlled trials assessing the effects of L-arginine and sildenafil citrate on IUGR. Outcomes analyzed were the birth weight, gestational age at labor, Apgar score at 1and 5 min, the ratio of NRDS, the ratio of ICH and neonatal death, etc.
RESULTS
Ten trials were included. Nine trials (576 patients) compared L-arginine with either placebo or no intervention. In the L-arginine treatment groups of the L-arginine trials, there was a significant increase in fetal birth weight (SMD 0.41, 95 % CI [0.24,0.58]), gestational age (SMD 0.30, 95 % CI [0.07,0.54]); L-arginine treatment group have a significant reduction in the ratio of neonatal respiratory distress syndrome (P = 0.009), intracranial hemorrhage of fetuses (P = 0.002), but the number of included studies and people on these outcomes are small. As only one trial (41 patients) compared sildenafil citrate with placebo, it was too small for reliable conclusions about possible differential effects could be drawn.
CONCLUSIONS
The results of this meta-analysis showed that L-arginine increased birth weight and prolonged gestational age at labor of IUGR fetuses. However, further large-scale RCTs are needed to adequately assess the effect of L-arginine and Sildenafil citrate on clinical outcomes, because the number of study may be small.
Topics: Apgar Score; Arginine; Birth Weight; Female; Fetal Growth Retardation; Gestational Age; Humans; Infant, Newborn; Phosphodiesterase 5 Inhibitors; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic; Sildenafil Citrate; Treatment Outcome
PubMed: 27528012
DOI: 10.1186/s12884-016-1009-6 -
Zhongguo Dang Dai Er Ke Za Zhi =... Mar 2021A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac...
A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.
Topics: Apgar Score; Child; Child, Preschool; China; Female; Humans; Infant, Newborn; Pregnancy; Resuscitation; Risk Factors
PubMed: 33691923
DOI: 10.7499/j.issn.1008-8830.2012020 -
Scientific Reports Oct 2021If the brain structure is assessed at neonatal intensive care units, covert clinical events related with subtle brain injury might be identified. The reduced scattering...
If the brain structure is assessed at neonatal intensive care units, covert clinical events related with subtle brain injury might be identified. The reduced scattering coefficient of near-infrared light (μ') obtained using time-resolved near-infrared spectroscopy from the forehead of infants is associated with gestational age, body weight and Apgar scores, presumably reflecting subtle changes of the brain related to foetal growth and birth transition. One hundred twenty-eight preterm and term infants were studied to test whether μ' obtained from the head at term-equivalent age is associated with foetal growth, birth transition and nutritional status after birth, which are key independent variables of developmental outcomes. As potential independent variables of μ', birth weight, Apgar scores, age at full enteral feeding and post-conceptional age at the study were assessed to represent foetal growth, birth transition and nutritional status after birth. Subsequently, higher μ' values were associated with higher Apgar scores (p = 0.003) and earlier establishment of enteral feeding (p < 0.001). The scattering property of near-infrared light within the neonatal brain might reflect changes associated with birth transition and nutritional status thereafter, which might be used as a non-invasive biomarker to identify covert independent variables of brain injury in preterm infants.
Topics: Apgar Score; Birth Weight; Brain; Enteral Nutrition; Female; Fetal Development; Gestational Age; Humans; Infant; Infant, Premature; Male; Nutritional Status; Spectroscopy, Near-Infrared
PubMed: 34716370
DOI: 10.1038/s41598-021-00624-9 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2022The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of... (Observational Study)
Observational Study
BACKGROUND
The surgical Apgar score (SAS) was defined by Gawande et al. in 2007. It has been shown that this scoring system was highly effective for predicting the incidence of post-operative complications and mortality. In this study, we aimed to define a new, modified SAS (mSAS) for predicting the incidence of post-operative complications and mortality in emergency surgery. We also wanted to quantify the effectiveness of this modified scoring system, comprising of the duration of the operation in addition to the three intraoperative parameters of the SAS score.
METHODS
Five hundred and seventy-nine patients who underwent emergency surgery were enrolled in this retrospective obser-vational study. At the end of the operation, the SAS was calculated from the data obtained from the examination of the patients and the mSAS was calculated by adding the duration of the operation to data used in the calculation of the SAS (Surgical duration >8 h; -4 points; 7.01-8 h; -3 points; 5.01-7 h; -2 points; 3.01-5 h; -1 points; 0-3 h; 0 points added).
RESULTS
There was a statistically significant relationship between the mSAS and the total number of complications (as operative time [OT] increased, the number of complications increased) (r=0.360; p=0.001). The compliance levels of the SAS and mSAS were 98.4% and they have been found as statistically significant (ICC: 0.984; p=0.001; p<0.01).
CONCLUSION
We suggest that the OT should be included as a simple, objective and practical indication of the SAS risk score in major operations. The mSAS was an independent predictor of post-operative mortality and complications. With the widespread use of electronic medical record systems and the effective use of pre-operative medical data, the mSAS can be used as an easy and new scoring system to predict prognosis.
Topics: Apgar Score; Humans; Infant, Newborn; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors
PubMed: 35485468
DOI: 10.14744/tjtes.2021.34732 -
Reproductive Health Feb 2020Accruing epidemiological evidence suggests that prenatal exposure to emissions from cooking fuel is associated with increased risks of adverse maternal and perinatal...
BACKGROUND
Accruing epidemiological evidence suggests that prenatal exposure to emissions from cooking fuel is associated with increased risks of adverse maternal and perinatal outcomes including hypertensive disorders of pregnancy, low birth weight, stillbirth and infant mortality. We aimed to investigate the relationship between cooking fuel use and various pregnancy related outcomes in a cohort of urban women from the Accra region of Ghana.
METHODS
Self-reported cooking fuel use was divided into "polluting" (wood, charcoal, crop residue and kerosene) and "clean" fuels (liquid petroleum gas and electricity) to examine 12 obstetric outcomes in a prospective cohort of pregnant women (N = 1010) recruited at < 17 weeks of gestation from Accra, Ghana. Logistic and multivariate linear regression analyses adjusted for BMI, maternal age, maternal education and socio-economic status asset index was conducted.
RESULTS
34% (n = 279) of 819 women with outcome data available for analysis used polluting fuel as their main cooking fuel. Using polluting cooking fuels was associated with perinatal mortality (aOR: 7.6, 95%CI: 1.67-36.0) and an adverse Apgar score (< 7) at 5 min (aOR:3.83, 95%CI: (1.44-10.11). The other outcomes (miscarriage, post-partum hemorrhage, pre-term birth, low birthweight, caesarian section, hypertensive disorders of pregnancy, small for gestational age, and Apgar score at 1 min) had non-statistically significant findings.
CONCLUSIONS
We report an increased likelihood of perinatal mortality, and adverse 5-min Apgar scores in association with polluting fuel use. Further research including details on extent of household fuel use exposure is recommended to better quantify the consequences of household fuel use.
STUDY REGISTRATION
Ghana Service Ethical Review Committee (GHS-ERC #: 07-9-11).
Topics: Female; Humans; Pregnancy; Air Pollution; Apgar Score; Cooking; Ghana; Obstetric Labor Complications; Perinatal Mortality; Pregnancy Outcome; Smoke; Infant, Newborn
PubMed: 32087720
DOI: 10.1186/s12978-020-0878-3