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PubMed1987

The relationship of Apgar scores, gestational age, and birthweight to survival of low-birthweight infants.

While Apgar scores provide a valid prediction of mortality in term infants (primarily reflecting asphyxia), intervening variables in premature newborns complicate interpretation. Physiologic states normal to preterm infants (such as, decreased muscle tone) can depress scores but may not influence survival significantly. Therefore the relationship between Apgar scores and survival in term and preterm infants differs. Because of the paucity of studies on preterm infants, we tested Apgar scores, as well as birthweight and gestational age, as outcome predictors in 748 low-birthweight infants (500-1800 gm). Our purpose was to assess the relationship between 1- and 5-minute Apgar scores and survival, and to evaluate all combinations of the four variables as outcome predictors. Univariate analysis showed a significant relationship between each of the four variables and survival; however, no single variable accounted for more than 32% of the variance in outcome, thus no single factor could be invoked as the major determinant of survival. Logistic regression analyses demonstrated the interrelationships of the four variables to survival. While both Apgar scores were related to survival, independent of the effects of birthweight and gestational age, they were slightly less predictive than either of these variables alone. However, when 1- and 5-minute Apgar scores were combined with gestational age, the predictive value was slightly better than any of the four variables alone or in other possible combinations.

Apgar Score↗
PubMed1995

Predicting low Apgar scores of infants weighing less than 1000 grams: the effect of corticosteroids.

OBJECTIVE: To evaluate maternal and neonatal factors that predict low Apgar scores in newborns weighing less than 1000 g. METHODS: From a data set of all live-born infants who were delivered between 1979-1991 and who weighed 1000 g or less, we reviewed the records of 837 neonates born at 24-28 weeks' gestation. Potential risk factors were evaluated for associations with a 1-minute Apgar score of 3 or less and a 5-minute Apgar score of 6 or less. Analyses used chi 2 test and multiple logistic regression. RESULTS: The prevalence of 1-minute Apgar scores of 3 or less decreased from 65.9% at 24 weeks to 38.2% at 28 weeks, and the prevalence of 5-minute Apgar scores of 6 or less decreased from 83.3% at 24 weeks to 51.2% at 28 weeks. As the birth weight increased from 500-599 g to 900-1000 g, 1-minute Apgar scores of 3 or less decreased from 77.0% to 39.6%, and 5-minute Apgar scores of 6 or less decreased from 89.2% to 56.4%. Aside from gestational age and birth weight, corticosteroid use was the strongest predictor of Apgar scores above 3 at 1 minute and above 6 at 5 minutes. Male and nonvertex-presenting infants had an increased likelihood of low Apgar scores, as did infants with cord blood pH less than 7.05 or bicarbonate value less than 17 mEq/L. CONCLUSION: Neonates at very low gestational ages and birth weights are more likely than larger or more mature infants to have low Apgar scores. Males, nonvertex-presenting infants, and those who are acidotic at birth also have an increased prevalence of low scores. Infants born to mothers treated with antenatal corticosteroids are less likely to have low Apgar scores. This finding indicates that antenatal corticosteroids may benefit the newborn at birth, before respiratory distress syndrome becomes apparent.

Adrenal Cortex Hormones↗
PubMed1989

[The Apgar score as a predictor of neurologic sequellae].

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

Apgar Score↗
PubMed1987

Low Apgar score as a risk factor for respiratory disturbances in the newborn infant.

The value of the Apgar score as a risk factor for all neonatal respiratory disturbances (RD) was evaluated in a prospective study of an unselected population. All liveborn infants (n = 4656) of mothers living in Gothenburg were screened over one year for signs of respiratory disease. This unselected population could be obtained since virtually all infants in Gothenburg are born in two maternity hospitals, with similar treatment principles, the same equipment standard and neonatal care. A low one minute Apgar score (less than 7) was found to be a powerful risk factor for RD in full term newborns and infants of 33-36 weeks gestation provided that the delivery had been vaginal. In these infants a low Apgar score at five minutes further increased the risk of RD. In immature infants less than 32 weeks and after cesarean section in all gestational ages a low Apgar score did not mean any additional risk of RD. The respiratory component in the Apgar score was not more predictive of RD than any of the others. In most infants with RD, irrespective of Apgar score, there was a few hours interval free from respiratory signs after birth. It has been well shown in other studies that Apgar score is not a reliable index of intrauterine or birth asphyxia. Nevertheless the one-minute score is a powerful predictor of neonatal respiratory difficulties. One explanation might be that Apgar score is correlated with sympathoadrenal activity at birth.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1993

Clinical evaluation of the fetus and neonate. Relation between intra-partum cardiotocography, Apgar score, cord blood acid-base status and neonatal morbidity.

The relation between intra-partum cardiotocography (CTG), cord blood acid-base status, Apgar score and neonatal morbidity was studied in 1228 consecutively live-born babies and in a subgroup of 200 babies (148 babies with a 1 min Apgar score < or = 8 and 52 randomly selected babies with a 1 min Apgar score > or = 9). The scores for the individual components of the 1 min Apgar score were strongly associated with each other, whereas the scores for the individual components of the 5 min Apgar score were less strongly associated. At 1 min the scores for muscle tone, reflex irritability and respiration but not the scores for heart rate and skin colour were associated with arterial and venous cord blood pH (low scores being associated with low pH). Out of the individual components of the Apgar score, heart rate and reflex irritability at 1 min were the best discriminators between "healthy or relatively healthy" and "severely ill" babies. Intrapartum CTG, total Apgar score and cord blood acid-base status were only weakly related. Venous cord blood pH was the best predictor of the 1 min Apgar score. Intra-partum CTG (silent pattern), 5 min Apgar score and venous cord blood pH were the best predictors of severe neonatal morbidity.

Acid-Base Equilibrium↗
PubMed1986

The Apgar score revisited: influence of gestational age.

We tested the hypothesis that Apgar scores are in part related to the newborn infant's level of maturity. Seventy-three pregnant women with normal fetuses of gestational age 22 to 42 weeks were studied. Fetal well-being was documented by a prospectively designed recording of pregnancy history, labor complications, and birth outcome, including cord blood pH and base deficit measurements. The 1- and 5-minute Apgar scores were directly related to gestational age. Respiratory efforts, muscle tone, and reflex were the major determinants for a decreasing Apgar score with declining gestational age. We conclude that the 1- and 5-minute Apgar scores are influenced by the infant's level of maturity and that our data may be useful in evaluating the true value of Apgar scores in assessing the fetal and neonatal condition of low birth weight infants.

Apgar Score↗
PubMedDate not supplied

The relationship between Apgar score and umbilical arterial blood gas values in newborns.

The data for this report were derived from 61 newborns and their mothers. Of the newborns 45.9 percent had one-minute Apgar scores of less than seven, and 54.1 percent had Apgar scores of seven or greater. The five-minute Apgar score was less than 7 in 6.6 percent of cases. While 23 percent of newborns had pH values of less than 7.20, 77 percent had pH of 7.20 or greater. Only 39.3 percent of the 28 newborns with one-minute Apgar score of less than 7 and 75 percent of the four newborns with five minute Apgar scores of less than 7 had pH values less than 7.20. Of 33 newborns, 9.1 percent who had Apgar scores of seven or more had pH of less than 7.20. We determined the sensitivity of the one minute Apgar score in acidemia to be 78 percent, the specificity to be 63 percent, the positive predictive value as 39 percent, and the negative predictive value as 90 percent. The one minute score is very poor for detecting acidosis when present but is rarely misleading when acidosis is absent. There was a positive correlation between the Apgar score and pH (p < 0.001). The best correlation with umbilical artery pH values was observed with base excess (-BE) values (p < 0.001). Severe acidosis (pH < 7.11) was detected in eight cases. As delta pH increases, pH, pO2 and HCO3 decrease and pCO2 increases. Of 11 infants with delta pH > or = 0.20, 63.6 percent were sick infants and only one (9%) had normal Apgar scores.

Acid-Base Equilibrium↗
PubMed1987

Umbilical cord blood pH and Apgar scores as an index of neonatal health.

In an effort to determine the clinical usefulness of Apgar scoring and cord pH in neonatal management, specimens of umbilical cord blood were obtained after 257 of 329 consecutive deliveries at a community-based hospital. A notable number of babies who were born in a vigorous state were in fact acidotic (umbilical arterial pH greater than 1 SD below mean). Seventy-two percent of acidotic babies had an Apgar score greater than 7 at 1 minute, and 92% had an Apgar score greater than 7 at 5 minutes. Correlation coefficients of Apgar scores at 1 and 5 minutes and arterial pH with the health status of newborn infants were poor. A chi 2 analysis of arterial pH and Apgar scores at 1 and 5 minutes indicated that a larger number of sick babies had an Apgar score less than 7 and acidosis than expected by pure chance. However, the sensitivity values of the Apgar score at 1 minute (0.48) and 5 minutes (0.24) and the arterial pH (0.40) for predicting sick children limit the clinical usefulness of these tests. While technically feasible in a community hospital, routine cord pH measurements add little to neonatal evaluation and management.

Acid-Base Equilibrium↗
PubMed2002

MRI lesions and infants with neonatal encephalopathy. Is the Apgar score predictive?

OBJECTIVE: The aim of this study was to establish whether, in full-term infants presenting with neonatal encephalopathy, the 1 minute Apgar score gives an indication of the presence, site or type of lesions observed on brain MRI in the neonatal period. PARTICIPANTS AND METHODS: The study cohort included 157 full-term infants who had neurological abnormalities during the first 48 hours after delivery. Infants with developmental, genetic, infective or metabolic diagnoses were excluded from the study. The infants were subdivided according to their 1 minute Apgar score into three groups as follows: Apgar score 0 - 3 (n = 108/157, 69 %), 4 - 7 (n = 29, 19 %), 8 - 10 (n = 21, 12 %). Results. Severe and moderate basal ganglia and thalamic (BGT) lesions, with one exception, were only observed in the group with an Apgar score of 3 or below. Minimal BGT lesions were, with one exception, associated with scores below 7 and mainly below 3. However, not all the infants with low Apgar scores had BGT lesions and 28 % of the patients with Apgar scores below 3 had normal scans or only minimal white matter changes. White matter lesions without BGT involvement were equally distributed in the cohort, irrespective of the Apgar scores. Cerebral infarction and scattered white matter haemorrhages were the most common findings in infants with Apgar scores of 4 and above. The Apgar scores were not always predictive of motor outcome at 2 years but the presence and severity of the sequelae mainly reflected the site and severity of MRI findings. CONCLUSIONS: These findings stress the importance of subdividing neonatal encephalopathy into diagnostic categories according to brain lesions if one wishes to study either causative factors or outcome.

Apgar Score↗
PubMed2005

A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings.

OBJECTIVE: To triangulate the Apgar score by using a crossdisciplinary approach and highlighting the differences that exist between actual everyday practice and accepted standards of scoring in contrasting populations of the world. STUDY DESIGN AND SETTING: Clinimetrics review of Apgar scoring. RESULTS: The Apgar scoring has weighting problems, rigid categorization, redundancy and subjectivity in its variables. Poor inter-rater reliability and equivocal validity mark its use in the present milieu. The ceiling and floor effects further hamper the evaluative responsiveness of scoring. Moreover, despite some recent evidence in its favor, the Apgar score has poor calibration when used as an isolated criterion to predict mortality and long-term morbidity, particularly in preterms. Also, the vigor of resuscitation (nature and duration), in essence, is beyond the realm of the Apgar score in contemporary resuscitation guidelines. In developed nations, with rapidly decreasing age of viability, and alternative modes of childbearing, threats to Apgar are more ominous today than before. On the other hand, in developing countries, feasibility problems due to unattended home deliveries and barriers to effective scoring in the overburdened and understaffed hospitals cast doubts about its accuracy as a measure of neonatal well-being. CONCLUSION: Use of the Apgar score definitely needs to be contextualized within the contemporary perinatal and neonatal care framework in different settings.

Apgar Score↗
PubMed1991

Apgar scores and cognitive performance at 17 years of age.

The association between low Apgar scores (7 or less) at 1 and 5 minutes and cognitive performance in late adolescence was assessed. A 17-year follow-up of 1942 subjects was performed. The intelligence test scores at 17 years of age were matched with 1- and 5-minutes Apgar scores. A multiple linear regression analysis was used to control for the possible confounding effect of perinatal factors (birth weight, gestational age, serum bilirubin levels, birth order) and demographic characteristics (ethnic origin, paternal education, social class). The sensitivity and positive predictive value of a low 1-minute Apgar score were 8 and 8% and of a low 5-minute Apgar score 1.5 and 5%, respectively. Low Apgar scores are poorly correlated with long-term intellectual outcome.

Adolescent↗
PubMed2003

Immediate outcome of babies with low Apgar score in Mulago Hospital, Uganda.

BACKGROUND: Birth asphyxia contributes significantly to perinatal morbidity and mortality especially in resource poor countries. Although the Apgar score has been in use for over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome have not been established in many sub-Saharan countries including Uganda. OBJECTIVE: To determine the prevalence of low Apgar score and establish immediate outcome and possible risk factors for poor outcome in babies with low Apgar score. SETTING: Labour wards, operating theatres and special baby care unit, Mulago Teaching and referral Hospital, Uganda. SUBJECTS: Babies delivered in Mulago Hospital between September and October 1999. Those with low Apgar scores, together with an equal number of babies with normal scores matched for sex as controls, were followed up for 48 hours. MEASUREMENTS: Clinical features, anthropometry, gestational age, oxygen saturation, blood glucose and autopsy of babies who died. MAIN OUTCOME MEASURES: Clinical improvement, death, complications such as HIE, RDS, aspiration pneumonia, hypoglycaemia, hypothermia, hypotension and hypoxaemia. RESULTS: The prevalence of low Apgar score at one and five minutes was 8.4% and 2.8% respectively. Adverse outcome was seen in 57.3% of cases: death in 12.1% and clinical complications in 45.2%. HIE occurred in 21.8%, hypoxaemia in 12.9%, hypoglycaemia in 16.9% and aspiration pneumonia in 4.8%. Maternal factors significantly associated with low Apgar scores included primiparity, abnormal delivery, age and medical diseases during pregnancy, while birth injuries and cord accidents were the baby factors. Poor outcome was associated with birth injury, hypothermia, hypoglycaemia, hypotension, aspiration pneumonia, hypoxaemia and severe birth asphyxia. CONCLUSION: Even though the prevalence of low Apgar was only 8.4%, adverse outcomes associated with it were observed in more than half the patients. Therefore there is need to carefully evaluate and monitor babies with low Apgar scores immediately after birth.

Adolescent↗
PubMed1991

Hematocrit in relation to Apgar scores in SGA infants.

SGA infants have an increased incidence of low Apgar scores. At the same time they frequently have a high hematocrit. Since both affect outcome, it is important to know if a relationship exists between these two factors. In a study of 139 SGA newborns many had low Apgar scores at one minute: 63% of the preterms and 29% of the fullterms. Frequent abnormal hematological findings included high hematocrit. We found a positive correlation between hematocrit and the Apgar score at one minute of life that was statistically significant. The babies with a high hematocrit had significantly more often good Apgar scores. The correlation was present in preterm babies (r = 0.55) as well as in fullterms (r = 0.32). It is concluded that a high hematocrit probably protects the SGA newborn against acute perinatal asphyxia. It is possible that both low Apgar scores and "normal" hematocrit are signs of a chronically impaired SGA fetus.

Apgar Score↗
PubMed1993

Apgar scores in the identification of sensorineural hearing loss.

Apgar scores of 0-4 at 1 minute and 0-6 at 5 minutes have been investigated as risk criteria in the Utah High Risk Hearing Screening Program. The 1990 Joint Committee on Infant Hearing (JCIH) statement recommended only an Apgar score of 0-3 at 5 minutes be included in a risk registry for sensorineural hearing loss (SNHL). An analysis of live births indicates the more lenient Utah cut-off criteria are justified. It is concluded that both of the Utah Apgar scores, even when moderately depressed, are sensitive risk factors for SNHL in infants. These findings suggest serious consideration be given to expanding the 1990 JCIH Apgar recommendation.

Apgar Score↗
PubMed1996

Influence of acid-base status at birth and Apgar scores on survival in 500-1000-g infants.

OBJECTIVE: To evaluate the influence of acid-base status at birth and Apgar scores on survival in very low birth weight infants. METHODS: We evaluated 1073 infants born alive and weighing 500-1000 g during 1979-1991; 658 had umbilical artery gas values examined. Apgar scores were assigned at 1 and 5 minutes after birth. Umbilical artery blood samples were collected at delivery for pH, carbon dioxide pressure (PCO2), and bicarbonate. Infants were grouped at 23-24, 25-26, 27-28, and 29 weeks or more. Using survival as the dependent variable, multiple logistic regression analyses were performed controlling for gestational age, birth weight, plurality, antenatal glucocorticoid use, mode of delivery, and year of birth, as well as for Apgar scores and cord blood gases. RESULTS: In every gestational age grouping, compared with infants with a pH lower than 7.05, survival was higher in infants with an umbilical artery pH of 7.05 or higher, significantly so at 27-28 weeks. There was no consistent relationship between umbilical artery PCO2 or bicarbonate and survival. However, with the exception of the 1-minute Apgar score at 23-24 weeks, the relationship of Apgar scores to survival was significant in all gestational age periods. Using multiple logistic regression analyses, the only significant relationships between any of the cord blood gases, Apgar scores, and mortality involved low 1-minute (odds ratio [OR] 2.7 [95% confidence interval (CI) 2.0-3.6]) and low 5-minute Apgar scores (OR 2.8 [95% CI 2.0-3.8]) and a bicarbonate less than 21 mEq/L (OR 1.6 [95% CI 1.1-2.4]). CONCLUSION: One- and 5-minute Apgar scores are better predictors of survival than umbilical artery blood gases in neonates weighing 500-1000 g at birth.

Acid-Base Equilibrium↗
PubMed1990

Mortality and immediate morbidity in term babies with low Apgar scores (Zimbabwe).

A retrospective study was undertaken to document immediate morbidity and mortality associated with low Apgar scores (5 or less) at 5 min in singleton term babies (37 weeks or more). From October 1986 to February 1987, 84 term babies had low Apgar scores, giving an incidence of 15/1000 live births. Overall mortality in these patients was 42%, and in those in whom Apgar scores remained 0-3 at 5 min, mortality was 77%. Evidence of severe-to-moderate hypoxic-ischaemic encephalopathy was noted in 44 (52%) and 17 (20%) failed to establish spontaneous respiration within the 1st few hours of life. Meconium aspiration syndrome was diagnosed in 29 (35%). A control group of 141 term babies with 5-min Apgar scores of 7 or more were identified and the presence of possible risk factors associated with low Apgar scores was assessed. Primiparity and prolonged second stages of labour in all parities were found to be significantly associated with low Apgar scores. Improved obstetric care and appropriate management of the newborn at delivery and in the neonatal period may help to reduce mortality and morbidity in some term babies.

Adult↗
PubMed2006

Apgar score and hospitalization for epilepsy in childhood: a registry-based cohort study.

BACKGROUND: A depressed Apgar score at 5 minutes is a marker for perinatal insults, including neurologic damage. We examined the association between 5-minute Apgar score and the risk of epilepsy hospitalization in childhood. METHODS: Using records linked from population registries, we conducted a cohort study among singleton children born alive in the period 1978-2001 in North Jutland County, Denmark. The first hospital discharge diagnosis of epilepsy during the follow-up time was the main outcome. We followed each child for up to 12 years, calculated absolute risks and risk differences, and used a Poisson regression model to estimate risk ratios for epilepsy hospitalization. We adjusted risk ratio estimates for birth weight, gestational age, mode of delivery, birth presentation, mother's age at delivery, and birth defects. RESULTS: One percent of the 131,853 eligible newborns had a 5-minute Apgar score <7. These children were more likely to be hospitalized with epilepsy during the follow-up than were children with an Apgar score of 7 or greater. The crude risk difference for epilepsy hospitalization was 2.5 cases per 100 (95% confidence interval [CI] 1.3 to 3.8). The risk difference estimates were greater in the presence of other perinatal risk factors. The adjusted risk ratio was 2.4 (95% CI 1.5 to 3.8). Half of the 12-year risk for epilepsy hospitalization in those with a depressed Apgar score occurred during the first year of life. The risk ratio during the first year of life was 4.9 (95% CI 2.0 to 12.3). CONCLUSION: An Apgar score <7 at five minutes predicts an increase in the subsequent risk of epilepsy hospitalization. This association is amplified by other perinatal risk factors.

Apgar Score↗
PubMed1990

Pregnancy and perinatal factors associated with persistently low Apgar scores: an analysis of the birth records of infants born in South Australia.

This study included all newborns with Apgar scores below seven at one minute after birth who were born in 1986 and whose births were notified to the South Australian Perinatal Statistics Collection. Univariate comparisons were made of the demographic, obstetric and pregnancy outcome characteristics of the 301 newborns whose Apgar scores remained below seven at five minutes and the 3165 whose scores recovered to seven or more. The results provide a general risk profile of the 301 newborn infants who perform poorly at birth, as indicated by a low Apgar score at both one and five minutes. Adverse risk factors identified in this study were similar to those for intellectual disability (mental retardation) and cerebral palsy in South Australia. It is suggested that persisting low Apgar scores, when combined with the other risk factors demonstrated in this and previous studies, would provide more reliable prognostic information than would Apgar scores alone. The study also shows that the majority of infants with low Apgar scores at one minute scored seven or better at five minutes. This demonstrates, that although a low one minute Apgar score has value in identifying newborns in need of immediate attention, it must be supplemented by the five minute score's stronger association with perinatal morbidity.

Apgar Score↗