-
Journal of Perinatology : Official... Dec 2019To determine 1-year survival in a cohort of newborns with an Apgar score of 0 at 5 and 10 min of age.
OBJECTIVE
To determine 1-year survival in a cohort of newborns with an Apgar score of 0 at 5 and 10 min of age.
STUDY DESIGN
A retrospective cohort study of the Washington State Comprehensive Hospital Abstract Reporting System from 2005 to 2014.
RESULTS
Of 879,340 births, 199 (0.02%) had an Apgar score of 0 at 5 min, and 109 (0.01%) also had a score of 0 at 10 min. One-year survival was 46% for newborns with Apgar score of 0 at 5 and 10 min. One-year survival by gestational age was 4% for newborns <30 weeks, 38% for 30-35 weeks, and 67% for ≥36 weeks.
CONCLUSION
Survival at 1 year of age for newborns with an Apgar score of 0 at 5 and 10 min has improved, as compared with historic cohorts. Cautious optimism is warranted since morbidity-free survival could not be assessed.
Topics: Apgar Score; Cohort Studies; Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Resuscitation Orders; Retrospective Studies; Risk Factors; Survival Analysis; Washington
PubMed: 31388116
DOI: 10.1038/s41372-019-0454-2 -
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 -
World Journal of Pediatrics : WJP Feb 2022Neonatal asphyxia is a serious public health issue. This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores, an important...
BACKGROUND
Neonatal asphyxia is a serious public health issue. This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores, an important proxy for neonatal asphyxia, in China from 2015 to 2016.
METHODS
The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24 (out of 34) provinces. Logistic regression analysis was performed to examine the risk factors for a low Apgar score (< 7). Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions. The population attributable risk percentage (PAR%) was calculated for each region-specific risk factor.
RESULTS
A total of 72,073 live births, including 320 births with low Apgar scores, were used for the analysis, giving a weighted rate of 3.9/1000 live births. There was a substantial difference in the incidence of low Apgar scores by geographic region, from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China. Maternal and obstetric factors are the major region-specific risk factors. In Southwest China, hypertensive disorders in pregnancy were more important contributors, with PAR% being 74.47%; in North and Northwest China, pre-pregnancy underweight was a more significant factor, with PAR% of 62.92%; in East China, infants born between 0:00 a.m. and 7:59 a.m. were a key factor, with PAR% of 80.44%.
CONCLUSION
Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.
Topics: Apgar Score; Asphyxia Neonatorum; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Risk Factors
PubMed: 34985717
DOI: 10.1007/s12519-021-00497-y -
Theriogenology Nov 2020The Apgar (appearance, pulse, grimace, attitude, respiration) score is an accepted method for assessing newborn viability in humans and domestic animals. The purpose of...
The Apgar (appearance, pulse, grimace, attitude, respiration) score is an accepted method for assessing newborn viability in humans and domestic animals. The purpose of this research was to modify an existing Apgar scoring system for lambs and compare Apgar score with litter size and birth order, as well as time-to-stand and time-to-suckle. Polypay lambs (n = 75) delivered naturally were used for this study. Pulse (<100 bpm = 0; 100-175 bpm = 1; >175 bpm = 2) and respiration (<45% SpO = 0; 45-65% SpO = 1; >65% SpO = 2) were measured with a pulse oximeter attached to the lamb's ear. Appearance, grimace, and attitude were assessed using mucous membrane color (cyanotic = 0; pale = 1; pink = 2); response to nose stimulation (no response = 0; moves head slightly = 1; shakes head = 2); and response to rump stimulation (no movement = 0; moves but no attempt to stand = 1; attempts to stand = 2), respectively. The Apgar score was measured within 5 min of birth (T0), 15 min (T15) and 60 min (T60) after birth. The time-to-stand and time-to-suckle were recorded and compared to Apgar scores. Apgar scores did not differ by litter size or birth order. There were no significant correlations between the Apgar scores and time-to-stand. There was a moderate positive correlation between attitude and time-to-suckle at T0 (R = 0.467), which may affect the ingestion of adequate colostrum in a timely manner. Producers may choose to consider using Apgar scoring so that assistance can be provided to lambs before serious complications arise.
Topics: Animals; Animals, Newborn; Apgar Score; Female; Humans; Infant, Newborn; Oximetry; Parturition; Pregnancy; Sheep; Sheep, Domestic
PubMed: 32827990
DOI: 10.1016/j.theriogenology.2020.08.010 -
JAMA Pediatrics Feb 2021
Topics: Apgar Score; Humans; Infant, Newborn; Pain
PubMed: 32926079
DOI: 10.1001/jamapediatrics.2020.2551 -
JAMA Pediatrics Feb 2021
Topics: Apgar Score; Humans; Infant, Newborn; Pain
PubMed: 32926080
DOI: 10.1001/jamapediatrics.2020.2560 -
European Journal of Cardio-thoracic... Apr 2023
Topics: Infant, Newborn; Humans; Apgar Score; Postoperative Complications; Blood Loss, Surgical; Lung Neoplasms
PubMed: 36912662
DOI: 10.1093/ejcts/ezad092 -
Journal of Perinatal Medicine Jun 2020Background Metabolic acidosis, measured in arterial umbilical cord blood at birth, is the most accepted definition of birth asphyxia. The aim of the study was to...
Background Metabolic acidosis, measured in arterial umbilical cord blood at birth, is the most accepted definition of birth asphyxia. The aim of the study was to investigate the rates of metabolic acidosis across the entire range of Apgar score values (0-10) at 1, 5, and 10 min in term infants. Methods In a population-based Swedish cohort of births between 2008 and 2013, we included 85,076 term (≥37 weeks) non-malformed infants with information from umbilical arterial blood gas analyses and complete information on Apgar scores (0-10) at 1, 5, and 10 min. Results Rates of metabolic acidosis generally decreased with increasing Apgar score values. For Apgar score at 1 min, this decrease was consistent from Apgar score 0 (35%) to Apgar score 10 (0%). For Apgar scores at 5 and 10 min, the decrease was consistent for Apgar score values from 6 to 10. Conclusion Although there is a close association between Apgar score values and rates of metabolic acidosis, Apgar score is not and should not be used as a measure of birth asphyxia.
Topics: Acidosis; Apgar Score; Asphyxia Neonatorum; Blood Gas Analysis; Cohort Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Male; Research Design; Sweden; Time Factors
PubMed: 32286248
DOI: 10.1515/jpm-2019-0429 -
Pregnancy Hypertension Jul 2020Obesity and preeclampsia in pregnant women are each independently associated with poorer neonatal outcomes. We study obesity and preeclampsia alone and also in...
OBJECTIVE
Obesity and preeclampsia in pregnant women are each independently associated with poorer neonatal outcomes. We study obesity and preeclampsia alone and also in combination in pregnant women to determine their association with neonatal outcomes.
STUDY DESIGN
This retrospective study (n = 664) compared four groups: 1) no preeclampsia/no obesity, 2) no preeclampsia/yes obesity, 3) yes preeclampsia/no obesity, and 4) yes preeclampsia/yes obesity. The primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes were low birth weight, low Apgar 1 score, and low Apgar 5 score.
RESULTS
Those with yes preeclampsia/yes obesity (OR:3.06, 95% CI:1.76, 5.32, p < 0.001) and those with yes preeclampsia/no obesity (OR:1.98, 95% CI:1.03, 3.80, p < 0.05) each had significantly higher odds for NICU admission. Those with no preeclampsia/yes obesity were not associated with NICU admission. Yes preeclampsia/yes obesity did not have any significant association with low birth weight, low Apgar 1 score, and low Apgar 5 score.
CONCLUSION
Patients with preeclampsia alone or preeclampsia/obesity combined are associated with higher odds for NICU admission. However, obesity alone without preeclampsia is not associated with NICU admission. This knowledge can allow the Pediatric service prior to delivery to prepare and mitigate potential poor neonatal complications.
Topics: Adult; Apgar Score; Case-Control Studies; Female; Gestational Age; Humans; Infant, Low Birth Weight; Intensive Care Units, Neonatal; Obesity; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 32629404
DOI: 10.1016/j.preghy.2020.05.016 -
Pediatrics International : Official... Jan 2022There is limited evidence concerning the impact on neonatal outcomes of different types of anesthesia used for cesarean delivery due to non-reassuring fetal status...
BACKGROUND
There is limited evidence concerning the impact on neonatal outcomes of different types of anesthesia used for cesarean delivery due to non-reassuring fetal status (NRFS). We aimed to assess the impact of NRFS and general anesthesia (GA) on neonatal outcomes in very-low-birthweight (VLBW) infants delivered by cesarean section.
METHODS
Data were collected relating to VLBW infants admitted to our institution. Infants were grouped into no-NRFS and NRFS groups and further subcategorized into GA and regional anesthesia (RA) subgroups. Neonatal outcomes were evaluated based on the presence of NRFS and the type of anesthesia.
RESULTS
A total of 356 infants were included. The GA subgroup in the no-NRFS group had higher requirements for respiratory support. However, GA was not associated with adverse neonatal outcomes based on the multivariable logistic regression analysis except for 5 min Apgar score <5. On the other hand, NRFS was associated with an increased risk of 5 min Apgar score <5 [adjusted odds ratio (aOR) 2.062, 95% confidence interval (CI) 1.064-3.997], use of high-frequency ventilation (aOR: 2.891, 95% CI: 1.477-5.658), and pulmonary hypertension (aOR: 2.890, 95% CI: 1.436-5.819).
CONCLUSIONS
In our cohort of VLBW infants, NRFS was a significant risk factor for a low 5 min Apgar score, increased respiratory support requirement, and pulmonary hypertension. Accurate assessment of fetal well-being, timely delivery, and presence of a resuscitation team fully aware of perinatal conditions and anesthetic impact is important.
Topics: Infant, Newborn; Pregnancy; Infant; Humans; Female; Cesarean Section; Hypertension, Pulmonary; Fetus; Infant, Very Low Birth Weight; Anesthetics; Apgar Score; Retrospective Studies
PubMed: 36198389
DOI: 10.1111/ped.15308