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PubMed2000

Clinical intra-amniotic infection with meconium-stained fluid at term: an analysis of Apgar scores.

A retrospective analysis of 1- and 5-minute Apgar scores of patients at term gestation (37 to 42 weeks) with evidence of clinical intra-amniotic infection and meconium-stained amniotic fluid was performed. The patients were selected from the labor and delivery records of two Detroit hospitals during the study period from January 1988 through May 1994. The author suggests that the presence of clinical intra-amniotic infection with meconium-stained fluid does not affect Apgar scores of term infants.

Amniotic Fluid↗
PubMed1985

[Perinatal fetal distress: correlations between Apgar score at birth and assay of CK-BB in umbilical cord blood].

32 newborn infant's umbilical cord blood CK-BB activity was tested at birth. 14 of them had a superior to 7 Apgar score at first and fifth minutes, whereas 18 newborn infant Apgar score was inferior to 7. The CK-BB activity was significantly higher in newborn infants having a low Apgar score at birth. A low Apgar score at first and fifth minutes together with a high CK-BB activity must be considered a nervous trouble signal and a warning in order to look after children's psychomotor skills more strictly and individual neurological damage.

Apgar Score↗
PubMed1975

[Has the pH meter replaced the Apgar score?].

The introduction of measuring the pH appears to place it in competition with Apgar scoring because of its precision. A study of this which has been carried out has illustrated that there are two different criteria for assessing the state of the infant at birth. The usual agreement between pH values and Apgar scoring can be broken when clinical fetal distress has become established before metabolic equilibrium of the infant has become modified. In these circumstances the Apgar score will be bad while the pH will be good.

Apgar Score↗
PubMed2006

Paternal age and Apgar scores of newborn infants.

BACKGROUND: New evidence suggests that advanced paternal age is a reproductive hazard, but we do not know whether paternal age affects the physical conditions of newborn infants as measured by the Apgar score. METHODS: We conducted a register-based cohort study of 70,347 couples and their first singleton infants by using data from the Danish Fertility Database (1980-1996). Information on Apgar score was obtained by linking the children to the National Birth Register. RESULTS: The odds ratio for having a baby with a 1-minute Apgar score of 1-3 was 1.64 (95% confidence interval = 1.08-2.48) for fathers 45 to 49 years of age and 1.49 (0.76-2.94) for fathers 50+ years compared with fathers 20 to 29 years (P for trend = 0.011). The risk of having a 5-minute Apgar score less than 7 increased among fathers 45+ years old (P for trend = 0.178). CONCLUSIONS: Our data suggest a modest effect of advanced paternal age on the Apgar score.

Adult↗
PubMed1999

Risk factors of delivery of low apgar score newborn below 7 at 1 minute: a case-control study.

To determine the significant risk factors of delivery of low Apgar score newborns below 7 at 1 minute, a case-control study was analysed in pregnant women delivered at Rajavithi Hospital between December 1, 1995 and June 30, 1996. Two hundred and two pregnant women who delivered low Apgar score newborns below 7 at 1 minute and four hundred and four pregnant women who delivered normal Apgar score newborns > or = 7 at 1 minute were recruited in the study by simple random, sampling. Risk factors which were significantly associated with low Apgar scores below 7 at 1 minute were gestational age less than 37 weeks or more than 42 weeks, birth weight less than 2,500 g or more than 4,000 g, meconium passage in the amnionic fluid, narcotic analgesic use and breech presentation. The non-significant risk factors were maternal medical or obstetric complications and oxytocin use.

Adult↗
PubMed1984

Obstetric analgesia, anaesthesia and the Apgar score.

This study examines the changing pattern of maternal analgesia administration during the decade 1970-1979. In addition, the relationship between analgesia, anaesthesia and the infant's Apgar score was documented. Approximately 40000 deliveries to South Glamorgan residents were included in the study. Over the two quinquennia 1970-1974 and 1975-1979 the administration of epidural block increased from 5.6% to 17.5%. The Apgar score of babies in the epidural block group was significantly better in the latter period. Respiratory depression following Caesarean section remains a problem. The group delivered by elective Caesarean section contained a substantial proportion of infants with a low Apgar score; 30% had an Apgar score less than 8 and 10% had a score of less than 4. Likely causative factors include undue sensitivity of the infants' respiratory centre and aortocaval compression during surgery.

Analgesia↗
PubMed1981

The relationship between electronic fetal monitoring and Apgar score.

A study was made of the relationship between electronic fetal heart monitoring and the Apgar score in 14,350 babies delivered between 1970 and 1975 at Beth Israel Hospital, Boston. Simple comparison of Apgar scores in monitored and unmonitored babies showed no difference at 5 minutes. When we controlled for gestational age and other potential confounders, a different pattern emerged. In a group of obviously high-risk pregnancies, monitored babies had a more favorable distribution of 5-minute Apgar scores (3.8% instead of 7.2% with a score below 6, P = 0.020). This group contained the 7.4% of all babies who were greater than or equal to 36 weeks of gestational age at highest risk (with problems such as hydramnios, multiple pregnancy, placental complication, or malpresentation). A similar trend for babies less than 36 weeks' gestational age with the same obstetric complications did not achieve statistical significance. There was no evidence for benefit in the other risk categories.

Apgar Score↗
PubMedDate not supplied

[Umbilical blood pH, Apgar scores, and early neonatal mortality].

BACKGROUND: For several decades Apgar scores and umbilical blood pH sampling have been routinely used in the assessment of newborns. The aim of this study was to examine the prognostic value of neonatal survival using population-based data and to put these analyses into context with international studies. MATERIAL AND METHODS: Data from 513,135 live births from the Perinatal Birth Register of Hesse, 1990 - 1999, were used. Death in the first week of life (early neonatal death) was used as endpoint of analyses. Receiver operator characteristic analyses were employed to compare the prognostic value of Apgar scores and umbilical blood pHs independently of cutoffs used. RESULTS: Scores and umbilical blood pH showed a strong association with early neonatal morality. The relative risk of early neonatal mortality in term infants with scores 0 - 3 yields a relative risk of 1193 (95 % confidence interval = 801 - 1778) compared with babies born with scores 7 - 10. Scores at 1, 5, and 10 minutes were superior in predicting early neonatal mortality compared to umbilical blood pH, independent of cutoffs used. CONCLUSIONS: Scores remain essential in the prediction of early neonatal survival. Umbilical blood pH is also strongly and significantly associated with early neonatal death, even though it is much less pronounced than the score. DISCUSSION: The poor mortality prediction of umbilical blood pH sampling in Hesse compared with umbilical blood pH sampling in a large American delivery unit with a highly standardized measuring routine may be explained by a lower proportion of extremely acidotic infants or may be attributable to a decreased proportion of or to a less unified or less reliable measurement of the umbilical blood pH in Hesse.

Acid-Base Equilibrium↗
PubMed1976

"Prediction" of the one-minute Apgar score from fetal heart rate data.

The value of any fetal monitoring technic is in its ability to predict infant outcome. In the present study, the ability of fetal heart rate (FHR) monitoring data to "predict" a measure of short-term infant outcome, the 1-minute Apgar score, was evaluated using univariate and multivariate statistical analyses. Of 61 monitored high-risk infants, 46 had high (7 to 10) and 15 had low (1 to 6) 1-minute Apgar scores. Computer analysis of FHR/intrauterine pressure (IUP) data for these 61 infants revealed that the infants with low Apgar scores had more than the expected number of late decelerations (LD). Using a threshold of ten LD and univariate analysis, 74% of the infants could be properly classified for high or low Apgar scores, but 60% of the infants with low Apgar scores were not identified. Using discriminant function (multivariate) analysis for the numbers of LD and uterine contractions, 47% of the depressed infants were appropriately identified and simple risk scoring equations were devised. Using additional observation vectors, including the number of accelerations and early decelerations, 67% of the depressed infants could be identified. The results of this study suggest that using multiple observation vectors improves the predictive capacity and, thus, the value of fetal monitoring data. Clinical experience suggests that the value of monitoring data can be further enhanced by simultaneous evaluation of other observation vectors from additional perinatal data sets using the technics of this study.

Analysis of Variance↗
PubMed1996

Use and abuse of the Apgar score. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists.

This is a revised statement published jointly with the American College of Obstetricians and Gynecologists that emphasizes the appropriate use of the Apgar Score. The highlights of the statement include: (1) the Apgar Score is useful in assessing the condition of the infant at birth; (2) the Apgar score alone should not be used as evidence that neurologic damage was caused by hypoxia that results in neurologic injury or from inappropriate intrapartum treatment; and (3) an infant who has had "asphyxia" proximate to delivery that is severe enough to result in acute neurologic injury should demonstrate all of the following: (a) profound metabolic or mixed acidemia (pH < 7.00) on an umbilical arterial blood sample, if obtained, (b) an Apgar score of 0 to 3 for longer than 5 minutes, (c) neurologic manifestation, eg, seizure, coma, or hypotonia, and (d) evidence of multiorgan dysfunction.

Apgar Score↗
PubMed1994

Depressed Apgar scores, acid-base status, and neurologic outcome.

OBJECTIVE: Our purpose was to determine the acid-base status of neonates with an Apgar score < or = 3 at 5 minutes and to ascertain whether accompanying acidemia is an important predictor of immediate newborn morbidity and long-term neurologic development. STUDY DESIGN: From January 1984 through December 1991 there were 28 newborns with gestational age > or = 34 weeks or birth weight > or = 2000 gm in whom the Apgar score at 5 minutes was < or = 3 and for whom umbilical cord arterial blood gas measurements were retrievable from the perinatal database. The neonates were grouped according to whether the immediate newborn course was complicated (n = 16) or uncomplicated (n = 12). Analysis of variables between these two groups and between those neonates in the complicated group who were later assessed to be developmentally normal (n = 6) or to have cerebral palsy (n = 6) was performed by Fisher's exact test, unpaired Student t test, Mann-Whitney U test, analysis of variance, or multiple logistic regression. RESULTS: Seventeen of 28 (60.7%) neonates with an Apgar score of < or = 3 at 5 minutes had an umbilical cord arterial pH > 7.00, and in 15 (53.6%) cases the pH was > 7.10. Neonates with a complicated newborn course had a significantly lower mean pH (6.94 +/- 0.19 vs 7.14 +/- 0.11, p < 0.01) and a significantly greater mean base deficit (14.8 +/- 6.3 mmol/L vs 6.4 +/- 4.0 mmol/L, p < 0.001). However, within this group there were no differences in umbilical cord arterial blood gas measurements between those children who were subsequently normal versus those with cerebral palsy. Multiple logistic regression analysis could not identify any newborn morbidity predictive of long-term neurologic development in those neonates with a complicated newborn course. CONCLUSIONS: Neonates with an Apgar score < or = 3 at 5 minutes and a complicated newborn course were more likely to be delivered by cesarean section for fetal heart rate abnormalities and to have lower umbilical cord arterial pH measurements and higher base deficit values than did their counterparts with an uncomplicated newborn course. No neonatal variable, however, was predictive of chronic neurologic disability within the group of neonates with a complicated newborn course.

Adult↗
PubMed1990

[Acid-base equilibrium in umbilical cord blood. Apgar score and acid-base equilibrium in umbilical cord blood as control parameters during labor].

Umbilical cord venous acid-base state was correlated to Apgar score at 1 and 5 minutes and to cerebral ultrasound and other clinical parameters in 295 consecutive deliveries. We present normal values for the whole sample and for normal vaginal deliveries. Most of the acidotic babies (pH less than 7,24) were clinically healthy (80% did not need intensive care in a neonatal department) and had normal Apgar scores (1 min score greater than 7 = 79% and 5 min score greater than 7 = 94%). Only a few of the babies transferred to the neonatal department were acidotic (13%) and had low Apgar scores (1 min score less than 7 = 15% and 5 min score less than 7 = 6%). The prognostic value of the three parameters for neonatal health is low using our definition of acidosis. It remains to be seen if acidosis without clinical symptoms of any significance has any influence on later development. Acid-base state showed better correlation with the optimal time of second stage of labour than Apgar score did. We found a slightly higher pH and a significantly higher base-excess with a long, as against a short second stage and pushing time. There was no difference between the second stage of delivery and the time of active pushing what concerns pH and base-excess. We do not recommend umbilical cord acid-base state as a routine for all deliveries. It should be used only in selected cases.

Acid-Base Equilibrium↗
PubMed2000

Outcome after successful resuscitation of babies born with apgar scores of 0 at both 1 and 5 minutes.

OBJECTIVE: Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes. STUDY DESIGN: Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, where available, of babies who met the above criteria occurring between January 1986 and February 1999 were reviewed. RESULTS: Thirty-three of 81,603 infants (0.4/1000 births) met our study criteria. Twenty-two (67%) babies died during hospitalization. Mortality decreased significantly from 100% for babies with a birth weight of <750 g to 38% for those weighing > or =2500 g at birth (P =.03). All 6 babies delivered before 26 weeks' gestation died. The incidence of 10-minute Apgar scores >0 was significantly higher among survivors than among those who subsequently died (82% vs 33%, P <.05). Nine survivors had hypoxic-ischemic encephalopathy diagnosed before discharge. Of the 7 infants with available follow-up, 4 had significant persisting morbidity. Two infants had normal neurologic examinations at follow-up. CONCLUSION: Survival in babies born with 1- and 5-minute Apgar scores of 0 is predicted by birth weight, gestational age, and 10-minute Apgar score. Long-term sequelae are common but not ensured.

Adult↗
PubMed1982

Maternal cigarette smoking, psychoactive substance use, and infant Apgar scores.

A study of 1,709 mother/child pairs at Boston City Hospital examined whether maternal cigarette smoking, drinking, or the use of other psychoactive substances was associated with low infant Apgar scores. The potential confounding effects of other labor and delivery risks were controlled in the analysis. In contrast to previous reports, univariate and stepwise multiple regression analyses did not identify a significant negative association between cigarette smoking and 1- or 5-minute Apgar scores. None of the substance use variables was significantly associated with low infant Apgar scores at 1 and 5 minutes. Other labor and delivery risks, such as short length of gestation, abnormal delivery presentation, placental abnormalities, nuchal cord, and exposure to general anesthesia during delivery, were associated with low Apgar scores.

Adult↗
PubMedDate not supplied

Correlation of ominous fetal heart rate pattern and scalp blood pH with one-minute Apgar score.

Fetal minitoring data were analyzed in 176 labors that developed ominous fetal heart rate deceleration patterns (FHRDP) during the two hours prior to delivery in an effort to identify how neonatal condition could be most accurately predicted. It was found that ominous FHRDP corresponded to a one-minute Apgar score of 6 or less in only 15.3% of cases. When patterns with fetal scalp blood pHs (FSBpH) of less than or equal to 7.20 (n = 18) were considered, 44.4% had an Apgar score of 6 or less. Mean Apgar scores for those neonates who had a pH of less than or equal to 7.20 were significantly less than the mean Apgar score of the control group (p less than 0.001 for all deceleration types). The result reveals that FSBpH has a better predictive value than FHRDP alone for neonatal depression. It is suggested that, as soon as ominous FHRDP occurs during labor, FSBpH be performed to assess not only fetal status but also to predict neonatal outcome.

Apgar Score↗
PubMed1999

Acquired microcephaly after low Apgar score in Zimbabwe.

Serial head circumference measurements were made on 165 African babies born with a 5 min Apgar score of 5 or less. Measurements were taken at birth and at 4, 9, and 12 months of age. In the majority of infants the onset of microcephaly could be diagnosed as early as 4 months of age. Twenty-five of the 142 infants were microcephalic at 1 year. Neurological development was impaired in 19 of the 25 (76 per cent) microcephalic infants and in 18 of the 117 (15 per cent) normocephalic infants. Fourteen of the 16 (88 per cent) infants with severe quadriplegia developed microcephaly before the age of 4 months. A decreased rate of head growth during the first 4 months of life in African infants born with a low Apgar score correlates closely with the development of microcephaly. Infants with an acquired microcephaly have a high probability of developing neurologic impairment by the age of 1 year. Serial head circumference measurement in low Apgar score babies in developing countries is an easy, simple, and inexpensive method to detect microcephaly.

Analysis of Variance↗