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The Journal of Maternal-fetal &... Dec 2023Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This... (Observational Study)
Observational Study
INTRODUCTION
Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia.
METHODS
This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases ( = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, = 92) and those with low lactate levels (below 2 mmol/L, = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, = 29, and high lactate group, = 45) were evaluated.
RESULTS
No difference was observed between the two groups in terms of demographic characteristics such as age ( = .1669), male gender ( = .906), mother's working situation ( = .948), mother's education level ( = .828), father's education level ( = .507), and family's total income ( = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, = .001), problem-solving (50 vs. 60, = .002), and personal social development (45 vs. 60, = .003). No difference was observed in terms of communication and gross motor total scores.
DISCUSSION
In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.
Topics: Child, Preschool; Female; Humans; Infant, Newborn; Male; Pregnancy; Apgar Score; Asphyxia; Asphyxia Neonatorum; Fetal Blood; Fetal Distress; Hypoxia; Lactic Acid
PubMed: 37989542
DOI: 10.1080/14767058.2023.2284115 -
Acta Obstetricia Et Gynecologica... Sep 2020The associations of epidural analgesia and low Apgar score found in the Swedish Registry might be a result of confounding by indication. The objective of this study was...
INTRODUCTION
The associations of epidural analgesia and low Apgar score found in the Swedish Registry might be a result of confounding by indication. The objective of this study was to assess the possible effect of intrapartum epidural analgesia on low Apgar score and neonatal intensive care unit (NICU) admission in term born singletons with propensity score matching.
MATERIAL AND METHODS
This was a propensity score matched study (n = 257 872) conducted in a national cohort of 715 449 term live born singletons without congenital anomalies in the Netherlands. Mothers with prelabor cesarean section were excluded. Main outcome measures were 5-minute Apgar score <7, 5-minute Apgar score <4 and admission to a NICU for at least 24 hours. First, an analysis of the underlying risk factors for low Apgar score <7 was performed. Multivariable analyses were applied to assess the effect of the main risk factor, intrapartum epidural analgesia, on low Apgar score to adjust the results for confounding factors. Second, a propensity score matched analysis on the main risk factors for epidural analgesia was applied. By propensity score matching the (confounding) characteristics of the women who received epidural analgesia with the characteristics of the control women without epidural analgesia, the effect of possible confounding by indication is minimized.
RESULTS
Intrapartum epidural analgesia was performed in 128 936 women (18%). Apgar score <7 was present in 1.0%, Apgar score <4 in .2% and NICU admission in .4% of the deliveries. The strongest risk factor for Apgar score <7 was epidural analgesia (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.8-2.0). The propensity score matched adjusted analysis of women with epidural analgesia showed significant adverse neonatal outcomes: aOR 1.8 (95% CI 1.7-1.9) for AS <7, aOR 1.6 (95% CI 1.4-1.9) for AS <4 and aOR 1.7 (95% CI 1.6-1.9) for NICU admission. The results of epidural analgesia on AS <7 were also significantly increased for spontaneous start of labor (aOR 2.0, 95% CI 1.8-2.1) and for spontaneous delivery.
CONCLUSIONS
Intrapartum epidural analgesia at term is strongly associated with low Apgar score and more NICU admissions, especially in spontaneous deliveries. This association needs further research and awareness.
Topics: Adult; Analgesia, Epidural; Apgar Score; Female; Humans; Infant, Newborn; Labor, Obstetric; Male; Maternal Age; Netherlands; Pregnancy; Propensity Score; Term Birth; Young Adult
PubMed: 32142154
DOI: 10.1111/aogs.13837 -
The Australian & New Zealand Journal of... Feb 2021Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on longer-term...
BACKGROUND
Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) on longer-term neurodevelopmental outcomes are less clear.
AIM
To examine the associations between Apgar scores of 0-5, 6, 7, 8 and 9 (compared with 10) and children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at age eight.
MATERIALS AND METHODS
We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)-reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics.
RESULTS
Risk differences comparing five-minute Apgar scores of 0-5 with Apgar scores of 10 for children performing ≤NMS for each domain were: reading (0.07 (95% CI -0.16 to 0.29)), writing (0.27 (95% CI -0.14 to 0.68)), spelling (0.15 (95% CI -0.10 to 0.40)), grammar (0.04 (95% CI -0.21 to 0.29)) and numeracy (0.21 (95% CI -0.04 to 0.45)). Risk differences for children performing ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10.
CONCLUSIONS
Children with five-minute Apgar scores of 0-5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years.
Topics: Apgar Score; Australia; Child; Educational Status; Female; Humans; Infant, Newborn; Pregnancy; Schools; South Australia
PubMed: 32830313
DOI: 10.1111/ajo.13220 -
European Journal of Obstetrics,... Jul 2022A rise in the rate of cesarean delivery (CD) has been found to be associated with a higher length of hospital stay, making it a public health concern. We aimed to...
INTRODUCTION
A rise in the rate of cesarean delivery (CD) has been found to be associated with a higher length of hospital stay, making it a public health concern. We aimed to evaluate risk factors for prolonged hospitalization following CD.
METHODS
A retrospective cohort study, in a single tertiary medical center, was conducted (2011-2019). Cesarean deliveries were categorized into three groups according to the postpartum length of stay (a) up to 3 days (the routine post cesarean hospital stay in our center, reference group) (b) 4-9 days, and (c) 10 days or above (prolonged hospitalization). Risk factors were examined using univariate analysis as well as multivariate logistic regression. A specific risk prediction score was developed to predict the need for prolonged hospitalization and ROC curve was assessed utilizing the performance of our model.
RESULTS
Overall, 87,424 deliveries occurred during the study period. Of them, 19,732 (22.5%) were cesarean deliveries. Hospitalization period was distributed as follows: 10,971 (55.6%) women were hospitalized for up to 3 days, 7,576 (38.4%) stayed for 4-9 days and 1,185 (6%) had a prolonged hospitalization period (≥10 days). Using multivariate analysis, multiple pregnancy (OR = 1.29, 95%CI 1.05-1.58), preterm delivery < 37 weeks (OR = 8.32, 95%CI 6.7-10.2), Apgar score < 7 (OR = 1.41, 95%CI 1.11-1.78) and non-elective CD (OR = 1.44, 95%CI 1.15-1.8) were identified as independent risk factors for prolonged hospitalization. Antenatal thrombocytopenia (PLT < 100 K) was found to be a protective factor (OR = 0.51, 95%CI 0.28-0.92). Our score model included antenatal risk factors and was found to be predicting the outcome, with an AUC of 0.845 (95%CI 0.83-0.86, p-value < 0.001).
CONCLUSION
A prediction score model for prolonged hospitalization after CD may be beneficial for risk assessment and post-partum management.
Topics: Apgar Score; Cesarean Section; Female; Hospitalization; Humans; Infant, Newborn; Length of Stay; Male; Pregnancy; Retrospective Studies
PubMed: 35567954
DOI: 10.1016/j.ejogrb.2022.04.026 -
The Veterinary Clinics of North... Mar 2021Neonatal maladjustment syndrome is characterized by depressed consciousness, neurologic signs, and reduced or nonexistent suckle reflex. Resuscitation compression...
Neonatal maladjustment syndrome is characterized by depressed consciousness, neurologic signs, and reduced or nonexistent suckle reflex. Resuscitation compression (squeezing) has been used in newborn foals and calves to reduce the behavioral symptoms of neonatal maladjustment syndrome. In this review, the authors describe how resuscitation compression can be used in newborn sheep. This technique can improve abnormal neonatal lamb behavior and encourage suckling in resistant lambs.
Topics: Animals; Animals, Newborn; Apgar Score; Central Nervous System Diseases; Female; Pressure; Sheep; Sheep Diseases; Sucking Behavior
PubMed: 33358064
DOI: 10.1016/j.cvfa.2020.10.006 -
Scientific Reports Jun 2021This study examined the contribution of the Apgar score at 1 and 5 min after birth to later cognitive functioning in 168 individuals with Down syndrome who were between...
This study examined the contribution of the Apgar score at 1 and 5 min after birth to later cognitive functioning in 168 individuals with Down syndrome who were between 6 and 25 years of age at time of cognitive testing. Our results showed that a lower Apgar score at 1 min was related to a worse performance in later cognitive measures of receptive vocabulary, verbal comprehension and production, visual memory and working memory. Results also showed that a lower Apgar score at 5 min was only related to worse later outcomes of verbal comprehension and production and auditory working memory. Our findings suggest a need for future studies investigating how specific perinatal events reflected in the Apgar score are linked to later cognitive functioning in individuals with Down syndrome.
Topics: Adolescent; Adult; Apgar Score; Child; Cognition; Comprehension; Down Syndrome; Female; Humans; Infant, Newborn; Male; Memory; Neuropsychological Tests; Vocabulary; Young Adult
PubMed: 34135349
DOI: 10.1038/s41598-021-90651-3 -
European Journal of Obstetrics,... Dec 2022Vaginal breech delivery (VBD) has been widely discouraged over the last two decades due to associated neonatal risks. However, many gynaecologists are still challenging...
BACKGROUND
Vaginal breech delivery (VBD) has been widely discouraged over the last two decades due to associated neonatal risks. However, many gynaecologists are still challenging this approach, at least in selected settings.
OBJECTIVE
To study short-term neonatal outcomes in singleton pregnancies undergoing VBD.
MATERIALS AND METHODS
Retrospective cohort study conducted on singleton pregnancies who delivered in breech presentation between 2012 and 2019. Neonatal complications in terms of mortality, umbilical artery (UA) pH, 5-min Apgar score, and postnatal admission to neonatal intensive care unit (NICU) were evaluated.
RESULTS
Overall, 804 breech deliveries were considered. Of these, 53.86 % had VBD, 26.62 % had emergency caesarean sections (CS) and 19.53 % had elective CS. No perinatal deaths were reported. After multivariate adjustment, VBD was associated with higher incidence of UA pH < 7.10 compared with both elective and emergency CS. No significant associations were found between VBD and UA pH < 7.00 or 5-min Apgar score < 3 or < 7. No significant differences in NICU hospitalization were observed for different modes of delivery. Gestational age was inversely correlated with UA pH < 7.00, 5-min Apgar score < 3 and < 7, and NICU hospitalization.
CONCLUSIONS
VBD in an experienced setting does not increase the risk of negative short-term perinatal outcomes significantly. Gestational age was the most important risk factor for low UA pH or 5-min Apgar score and NICU hospitalization, independent of mode of delivery.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Retrospective Studies; Breech Presentation; Delivery, Obstetric; Cesarean Section; Apgar Score
PubMed: 36334374
DOI: 10.1016/j.ejogrb.2022.10.022 -
Twin Research and Human Genetics : the... Apr 2021There are few studies on twins in Ecuador and Latin America. It requires a better understanding of perinatal conditions, especially from an ethnic perspective. This work... (Observational Study)
Observational Study
There are few studies on twins in Ecuador and Latin America. It requires a better understanding of perinatal conditions, especially from an ethnic perspective. This work aims to assess perinatal factors related to twin pregnancy in Ecuadorian Mestizo individuals. We performed an epidemiological, observational and cross-sectional study at the Hospital San Francisco and Hospital Nueva Aurora in Quito, Ecuador, from November 2019 to January 2020. It included 203 newborns from twin pregnancies, including mothers with and without pathological history. The average gestational age was 31 weeks, and the APGAR score at first minute was 6.86, with significant differences. Regarding the metabolic balance, the mean pH was 6.14; and bicarbonate was 11.57, with significant differences. Twins had intrauterine growth restriction in 6.9% of cases, with significant differences (p = .003); 81.4% required supplemental oxygen, with significant differences (p = .002); 93% required noninvasive mechanical ventilation (NIMV), with significant differences (p = . 003); 93% required inotropic and sedation, with substantial differences; 69% required antibiotics (≥21 days), with significant differences (p = .014); and 17.2% needed between 8 to 14 days of hospitalization, and 51% more than 28 days, with significant differences. The studied mothers' demographic profile was mostly Mestizos, with an average age of 32 years, and 93% had a poverty status. Most of the twins were diamniotic monochorial and were discordant twins. It found jaundice, premature anemia and sepsis in 100% of twins and hyaline membrane disease in 89.66% of twins. Twins of women with relevant prenatal care had more premature births (30.4 ± 2.6 weeks), more acid-base imbalance, APGAR at ≥7 min in 90% of cases, and patent ductus arteriosus in all. There was also a greater need for double intensive phototherapy than twins of healthy women.
Topics: Adult; Apgar Score; Cross-Sectional Studies; Ecuador; Female; Humans; Infant; Infant, Newborn; Pregnancy; Pregnancy, Twin; Twins
PubMed: 33752776
DOI: 10.1017/thg.2021.12 -
Journal of Obstetrics and Gynaecology :... Aug 2020This study aimed to identify the maternal, labour and newborn risk factors associated with an Apgar score of ≤3 in the first minute of life. This was a cross-sectional...
This study aimed to identify the maternal, labour and newborn risk factors associated with an Apgar score of ≤3 in the first minute of life. This was a cross-sectional evaluation from an internal database information system in a tertiary referral obstetric and neonatal centre. Newborns with gestational age ≥24 weeks and birth weight ≥500 g with a registered Apgar score in the first minute of life were included. A total of 4475 newborns had an Apgar score >3 and 154 newborns had an Apgar score ≤3 in the first minute of life. A multivariate analysis revealed that eclampsia (OR = 31.53), twin pregnancy (OR = 7.06), analgesia (OR = 1.97), prematurity (OR = 2.00) and caesarean section (OR = 2.06) were risk factors for an Apgar score ≤3 in the first minute of life. Identification of these risk factors indicates prompt assistance during prenatal and labour care to prevent neonatal hypoxia and low Apgar scores, identifying newborns that may need resuscitation procedures.Impact Statement Adequate prenatal care and proper labour management are the main factors that reduce the risk of complications at birth. The Apgar score at the first minute of life reflects conditions during labour but it is not a parameter that indicates resuscitation procedures. Previous studies have reported the association Apgar score at five minutes of life with the neonatal outcome. This study identifies risk factors associated with an Apgar score ≤3 in the first minute of life in a tertiary referral hospital. Eclampsia was the greatest independent risk factor, increasing by 31 times the risk of having an Apgar score ≤3 in the first minute of life. Identification of these risk factors, especially prompt treatment antenataly and during labour for hypertensive pregnant women, can prevent neonatal hypoxia and reduce the number of newborns that may need resuscitation procedures.
Topics: Adult; Analgesia, Obstetrical; Apgar Score; Cesarean Section; Cross-Sectional Studies; Databases, Factual; Eclampsia; Female; Gestational Age; Hospitals, Maternity; Humans; Infant, Newborn; Infant, Newborn, Diseases; Multivariate Analysis; Perinatal Care; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Premature Birth; Risk Factors; Tertiary Care Centers
PubMed: 32098552
DOI: 10.1080/01443615.2019.1673708 -
Journal of Clinical Anesthesia Dec 2021To develop and validate a simple delirium-predicting scoring system in patients undergoing major abdominal surgery by incorporating preoperative risk factors and... (Observational Study)
Observational Study
Development and validation of a risk score for predicting postoperative delirium after major abdominal surgery by incorporating preoperative risk factors and surgical Apgar score.
STUDY OBJECTIVE
To develop and validate a simple delirium-predicting scoring system in patients undergoing major abdominal surgery by incorporating preoperative risk factors and intraoperative surgical Apgar score (SAS).
DESIGN
Observational retrospective cohort study.
SETTING
A tertiary general hospital in China.
PATIENTS
1055 patients who received major abdominal surgery from January 2015 to December 2019.
MEASUREMENTS
We collected data on preoperative and intraoperative variables, and postoperative delirium. A risk scoring system for postoperative delirium in patients after major open abdominal surgery was developed and validated based on traditional logistic regression model. The elastic net algorithm was further developed and evaluated.
MAIN RESULTS
The incidence of postoperative delirium was 17.8% (188/1055) in these patients. They were randomly divided into the development (n = 713) and validation (n = 342) cohorts. Both the logistic regression model and the elastic net regression model identified that advanced age, arrythmia, hypoalbuminemia, coagulation dysfunction, mental illness or cognitive impairments and low surgical Apgar score are related with increased risk of postoperative delirium. The elastic net algorithm has an area under the receiver operating characteristic curve (AUROC) of 0.842 and 0.822 in the development and validation cohorts, respectively. A prognostic score was calculated using the following formula: Prognostic score = Age classification (0 to 3 points) + arrythmia + 2 * hypoalbuminemia + 2 * coagulation dysfunction + 4 * mental illness or cognitive impairments + (10-surgical Apgar score). The 22-point risk scoring system had good discrimination and calibration with an AUROC of 0.823 and 0.834, and a non-significant Hosmer-Lemeshow test P = 0.317 and P = 0.853 in the development and validation cohorts, respectively. The bootstrapping internal verification method (R = 1000) yielded a C-index of 0.822 (95% CI: 0.759-0.857).
CONCLUSION
The prognostic scoring system, which used both preoperative risk factors and surgical Apgar score, serves as a good first step toward a clinically useful predictive model for postoperative delirium in patients undergoing major open abdominal surgery.
Topics: Abdomen; Apgar Score; Delirium; Humans; Infant, Newborn; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 34237489
DOI: 10.1016/j.jclinane.2021.110408