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BMC Pregnancy and Childbirth Aug 2022Apgar score is used to evaluate the neonates' overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar...
Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study.
BACKGROUND
Apgar score is used to evaluate the neonates' overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section.
METHODS
An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score > = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05.
RESULT
Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019.
CONCLUSIONS
Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..
Topics: Adult; Apgar Score; Asphyxia; Asphyxia Neonatorum; Birth Weight; Case-Control Studies; Cesarean Section; Ethiopia; Female; Hemorrhage; Hospitals, Special; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Universities
PubMed: 36028804
DOI: 10.1186/s12884-022-04999-z -
BMC Anesthesiology Apr 2021Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of... (Comparative Study)
Comparative Study
BACKGROUND
Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length.
METHODS
A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records.
RESULTS
The prevalence of using LEA in multiprous women was 54.5 %. Using LEA significantly lengthened the duration of labor stage by 56 min (P < 0.001), increased the blood loss (P < 0.001) and lowered Apgar scores (P = 0.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.014), while there was no significant difference with 4 cm or more cervical dilation (P = 0.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.035), meanwhile there were no significantly differences in the women with 4 cm or more cervical dilation (P = 0.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2 cm cervical dilation (P = 0.001) and 4 cm or more cervical dilation (P = 0.025), while there were no significantly differences in the women with 3 cm cervical dilation (P = 0.839).
CONCLUSIONS
Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3 cm and the different effect should be understand.
TRIAL REGISTRATION
ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, http://www.chictr.org.cn .
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Apgar Score; Case-Control Studies; Female; Humans; Infant, Newborn; Labor Pain; Labor Stage, First; Labor, Obstetric; Parity; Pregnancy; Retrospective Studies; Time Factors; Uterine Hemorrhage
PubMed: 33910504
DOI: 10.1186/s12871-021-01355-0 -
PloS One 2021Endogenous erythropoietin (EPO) concentrations vary widely in preterm infants and may be associated with perinatal risk factors and neurological outcomes. Erythropoietin...
BACKGROUND
Endogenous erythropoietin (EPO) concentrations vary widely in preterm infants and may be associated with perinatal risk factors and neurological outcomes. Erythropoietin is elevated in fetal hypoxia but is also a potential neuroprotectant.
METHODS
In a prospective study of 27 infants ≤ 30 weeks gestation, serum erythropoietin concentrations were measured during the first month of life, on day 1 and weeks 1, 2, and 4, and related to perinatal risk factors and outcomes including retinopathy of prematurity and cerebral injury evaluated near term-equivalent post menstrual age using magnetic resonance imaging with quantitative scoring.
RESULTS
Lower birth weight was associated with higher EPO concentrations throughout the first 2 weeks of life (r = -0.6, p < 0.01). Higher day 1 and week 1 EPO concentrations were associated with lower Apgar score at 1 minute (r = - 0.5) and 5 minutes (r = -0.7), respectively (p < 0.01). Higher day 1 EPO concentrations and 2-week area under the curve were associated with increased risk (p = 0.01) and severity (r = 0.5, p < 0.02) of retinopathy of prematurity. Higher EPO concentrations at 2 weeks were associated with increased total brain injury score (r = 0.5, p < 0.05).
CONCLUSION
Elevated endogenous erythropoietin concentrations in the first two weeks of life are associated with lower birth weight and increased risk of adverse outcomes.
Topics: Age Factors; Apgar Score; Brain Injuries; Erythropoietin; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Male; Pregnancy; Prospective Studies; Retinopathy of Prematurity
PubMed: 34077474
DOI: 10.1371/journal.pone.0252655 -
BMC Surgery Dec 2022Postoperative complications and mortality following laparotomy have remained high worldwide. Early postoperative risk stratification is essential to improve outcomes and... (Observational Study)
Observational Study
BACKGROUND
Postoperative complications and mortality following laparotomy have remained high worldwide. Early postoperative risk stratification is essential to improve outcomes and clinical care. The surgical Apgar score (SAS) is a simple and objective bedside prediction tool that can guide a surgeon's postoperative decision making. The objective of this study was to evaluate the performance of SAS in predicting outcomes in patients undergoing laparotomy at Mulago hospital.
METHOD
A prospective observational study was conducted among eligible adult patients undergoing laparotomy at Mulago hospital and followed up for 4 months. We collected data on the patient's preoperative and intraoperative characteristics. Using the data generated, SAS was calculated, and patients were classified into 3 groups namely: low (8-10), medium (5-7), and high (0-4). Primary outcomes were in-hospital major complications and mortality. Data was presented as proportions or mean (standard deviation) or median (interquartile range) as appropriate. We used inferential statistics to determine the association between the SAS and the primary outcomes while the SAS discriminatory ability was determined from the receiver-operating curve (ROC) analysis.
RESULTS
Of the 151 participants recruited, 103 (68.2%) were male and the mean age was 40.6 ± 15. Overall postoperative in-hospital major complications and mortality rates were 24.2% and 10.6%, respectively. The participants with a high SAS category had an18.4 times risk (95% CI, 1.9-177, p = 0.012) of developing major complications, while those in medium SAS category had 3.9 times risk (95% CI, 1.01-15.26, p = 0.048) of dying. SAS had a fair discriminatory ability for in-hospital major complications and mortality with the area under the curve of 0.75 and 0.77, respectively. The sensitivity and specificity of SAS ≤ 6 for major complications were 60.5% and 81.14% respectively, and for death 54.8% and 81.3%, respectively.
CONCLUSION
SAS of ≤ 6 is associated with an increased risk of major complications and/or mortality. SAS has a high specificity with an overall fair discriminatory ability of predicting the risk of developing in-hospital major complications and/or death following laparotomy.
Topics: Adult; Infant, Newborn; Humans; Male; Middle Aged; Female; Laparotomy; Prospective Studies; Apgar Score; Uganda; Postoperative Complications; Referral and Consultation; Hospitals; Retrospective Studies
PubMed: 36529732
DOI: 10.1186/s12893-022-01883-7 -
Pediatrics and Neonatology Mar 2021To characterize the prevalence and profile of drug-drug interactions (DDIs), the drugs most related to major DDIs and risk factors of their prescription in a neonatal...
BACKGROUND
To characterize the prevalence and profile of drug-drug interactions (DDIs), the drugs most related to major DDIs and risk factors of their prescription in a neonatal intensive care unit (NICU).
METHODS
Neonates admitted to a NICU who had at least one medication prescribed and a hospital stay >24 h were included in a prospective cohort study (August 2017 to July 2018). All medications prescribed during the hospitalization were collected from all neonates (n = 220), with the screening for DDIs. Prevalence and type of DDIs was identified. Network analysis was used to identify the drugs more implicated with DDIs. Logistic regression was used for the analysis of risk factors (p < 0.05).
RESULTS
Over 70% of neonates were exposed to DDIs and 29% were exposed to major DDIs. The network analysis identified furosemide, fentanyl, aminophylline and fluconazole as most implicated with DDI, fentanyl was especially associated with major DDIs. The number of drugs (OR 1.60, p < 0.01), caesarean delivery (OR 2.68, p < 0.05), gestational age (OR 1.03, p < 0.01) and APGAR score (OR 0.78, p < 0.01) were identified as risk factors for exposure to DDI.
CONCLUSION
Neonates in intensive care have a high exposure to DDIs and the occurrence of major DDIs is related specifically to the prescription of fentanyl. The number of prescribed drugs, gestational age, cesarean delivery and low APGAR score in the first minute were identified as risk factors for DDIs in NICU.
Topics: Apgar Score; Cesarean Section; Cohort Studies; Drug Interactions; Drug Utilization; Female; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Male; Pregnancy; Risk Factors
PubMed: 33158761
DOI: 10.1016/j.pedneo.2020.10.006 -
Revista Brasileira de Enfermagem 2020To investigate the association between analgesia during labor and occurrence of neonatal outcomes.
OBJETIVE
To investigate the association between analgesia during labor and occurrence of neonatal outcomes.
METHOD
Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors.
RESULTS
Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments.
CONCLUSION
The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.
Topics: Adolescent; Adult; Analgesia, Obstetrical; Apgar Score; Brazil; Cohort Studies; Female; Humans; Infant, Newborn; Labor, Obstetric; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Risk Factors
PubMed: 32609198
DOI: 10.1590/0034-7167-2018-0757 -
Revista Brasileira de Enfermagem 2020To investigate the association between analgesia during labor and occurrence of neonatal outcomes.
OBJETIVES
To investigate the association between analgesia during labor and occurrence of neonatal outcomes.
METHODS
Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors.
RESULTS
Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments.
CONCLUSIONS
The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.
Topics: Adolescent; Adult; Analgesia, Obstetrical; Apgar Score; Chi-Square Distribution; Cohort Studies; Female; Humans; Infant, Newborn; Labor, Obstetric; Logistic Models; Odds Ratio; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors
PubMed: 32236376
DOI: 10.1590/0034-7167-2018-0757 -
Therapeutic Hypothermia and Temperature... Mar 2019Therapeutic hypothermia following neonatal encephalopathy is neuroprotective. However, approximately one in two cooled infants still die or develop permanent...
Therapeutic hypothermia following neonatal encephalopathy is neuroprotective. However, approximately one in two cooled infants still die or develop permanent neurological impairments. Further understanding of variables associated with the effectiveness of cooling is important to improve the therapeutic regimen. To identify clinical factors associated with short-term outcomes of cooled infants, clinical data of 509 cooled infants registered to the Baby Cooling Registry of Japan between 2012 and 2014 were evaluated. Independent variables of death during the initial hospitalization and survival discharge from the cooling hospital at ≤28 days of life were assessed. Death was associated with higher Thompson scores at admission (p < 0.001); higher heart rates after 3-72 hours of cooling (p < 0.001); and higher body temperature after 24 hours of cooling (p = 0.002). Survival discharge was associated with higher 10 minutes Apgar scores (p < 0.001); higher blood pH and base excess (both p < 0.001); lower Thompson scores (at admission and after 24 hours of cooling; both p < 0.001); lower heart rates at initiating cooling (p = 0.003) and after 24 hours of cooling (p < 0.001) and lower average values after 3-72 hours of cooling (p < 0.001); higher body temperature at admission (p < 0.001); and lower body temperature after 24 hours and lower mean values after 3-72 hours of cooling (both p < 0.001). Survival discharge was best explained by higher blood pH (p < 0.05), higher body temperature at admission (p < 0.01), and lower body temperature and heart rate after 24 hours of cooling (p < 0.01 and <0.001, respectively). Lower heart rate, higher body temperature at admission, and lower body temperature during cooling were associated with favorable short-term outcomes.
Topics: Apgar Score; Body Temperature; Brain Diseases; Cohort Studies; Female; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypothermia, Induced; Infant, Newborn; Japan; Male; Registries; Survival Analysis; Treatment Outcome
PubMed: 30230963
DOI: 10.1089/ther.2018.0019 -
Acta Obstetricia Et Gynecologica... Dec 2022There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to...
INTRODUCTION
There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in term pregnancies.
MATERIAL AND METHODS
The study design was a historical cohort study using data from the Swedish Medical Birth Register, singletons in cephalic presentation with births 39+0 to 41+6 weeks, with available information on maternal BMI 2005-2017 (n = 352 567). Modified Poisson regression analyses were used to investigate the association between gestational duration and stillbirth or death before 45 postmenstrual weeks (primary outcome) and Apgar score <7 at 5 minutes (secondary outcome) by BMI, respectively. Adjustments were made for maternal age, smoking, country of birth and educational level.
RESULTS
The adjusted relative risk (ARR) of stillbirth or death before 45 weeks among infants born at 41+0 to 41+6 vs 40+0 to 40+6 weeks, was 1.26 with a 95% confidence interval (CI) of 1.07-1.48. Among women with BMI ≥30, the offspring mortality risk in pregnancies lasting 39+0 to 39+2 weeks was significantly above the corresponding risk among women of normal BMI who delivered at 41+0 to 41+2 weeks (ARR = 1.95; 95% CI 1.07-3.56) but no statistically significant heterogeneity was found regarding the magnitude of the association between gestational duration and offspring mortality. The ARR, for Apgar <7 at 5 minutes (41+0 to 41+6 vs 40+0 to 40+6 weeks, regardless of BMI), was 1.36 (95% CI 1.27-1.45). The risk for low Apgar score at 41+0 weeks was 1.5% among all children regardless of maternal BMI. Among children to women with BMI ≥30, this magnitude of risk was found already at 39+3 weeks.
CONCLUSIONS
In primiparous women with obesity the risk of stillbirth or death before 45 postmenstrual weeks were increased throughout all full-term gestational age categories, compared with women with overweight or normal BMI. Children to obese women had the same risk for Apgar scores <7 at 5 minutes compared with women overall at earlier gestational age. The results suggest that maternal BMI needs to be considered when discussing timing of elective induction in term healthy pregnancies of primiparous women.
Topics: Infant, Newborn; Infant; Child; Pregnancy; Female; Humans; Body Mass Index; Stillbirth; Cohort Studies; Apgar Score; Gestational Age; Obesity; Risk Factors; Pregnancy Outcome
PubMed: 36168197
DOI: 10.1111/aogs.14465 -
BMJ (Clinical Research Ed.) May 2019To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity.
OBJECTIVE
To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity.
DESIGN
Population based cohort study.
SETTING
Sweden.
PARTICIPANTS
1 551 436 non-malformed live singleton infants, born at term (≥37 weeks' gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes.
EXPOSURES
Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively.
MAIN OUTCOME MEASURES
Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated.
RESULTS
Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes.
CONCLUSIONS
In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).
Topics: Adult; Apgar Score; Body Mass Index; Educational Status; Female; Health Surveys; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Male; Maternal Age; Mothers; Odds Ratio; Pregnancy; Prospective Studies; Risk Factors; Severity of Illness Index; Sweden; Term Birth; Time Factors; Young Adult
PubMed: 31064770
DOI: 10.1136/bmj.l1656