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PubMed1978

Child abuse. Its relationship to birthweight, apgar score, and developmental testing.

Fifty-two abused and 23 nonabused children from a low socioeconomic group were studied with respect to birthweight, five-minute Apgar score, and developmental quotients. An association was found between low Apgar scores, low birthweight, poor performance on developmental testing, and child abuse. Furthermore, it was found that among children with normal birthweights, abused children tended to have lower Apgar scores and significantly lower developmental quotients. This study suggests that among this group of children, abuse and subsequent poor performance may be related not only to the socioeconomic status of the children but also to the characteristics the child brings to the parent-child relationship and to the abusive environment.

Apgar Score↗
PubMed1981

The influence of cord complications on fetal pH, neonatal Apgar score, and the acid base state and oxygenation of the umbilical artery and vein.

Continuous monitoring of fetal scalp tissue pH (tpH), acid base and oxygenation measurements of the blood of the umbilical artery and vein, and APGAR scoring was performed in 152 deliveries. The effect of cord complication on tpH (120, 90, 60, 30, 15, 10, 5, and 0 minutes before delivery), the status of the umbilical artery and vein (pH, pCO2, base excess, standard bicarbonate, pO2, and oxygen saturation), and the APGAR scores (one and five minutes after delivery) were investigated. Thirty-two per cent of the deliveries were associated with on or more cord complication(s). Cord complications in general did not influence the APGAR scores, the acid base state, or the oxygenation of the fetus and newborn. In the very few cases of tight cord complication(s) tpH showed a marked decrease during the last 30 minutes of labour, the umbilical blood was slightly acidotic, but the APGAR scores were normal (8-10 one and five minutes after delivery). No cases of prolapse of the cord were found. Cord complications are very common but in most cases completely harmless.

Acid-Base Equilibrium↗
PubMed2000

Investigation of the relationship between low Apgar scores and early neonatal thyroid function.

BACKGROUND: The aim of the present study was to assess the effects of low Apgar scores on perinatal thyroid function. METHODS: Forty full-term infants delivered by the normal spontaneous vaginal route were enrolled into the study. All babies had 1 and 5 min Apgar scores below 4. The control group consisted of 26 full-term healthy neonates. Cord blood and serum tri-iodothyronine (T3), thyroxine (T4), reverse tri-iodothyronine (rT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH) and thyroid-binding globulin (TBG) determinations were performed by an enzyme immunoassay method. RESULTS: The mean values of FT4 and T4 observed in the cord blood of the study group were significantly lower compared with matched controls, whereas the mean TSH values were significantly higher. There were no differences in concentrations of T3, rT3 and TBG between the two groups. CONCLUSIONS: These results demonstrate the existence of transient hypothyroidism at birth in babies with Apgar scores below 4 delivered by the spontaneous vaginal route.

Apgar Score↗
PubMed1988

Evaluating the risks of cesarean section: low Apgar score in repeat C-section and vaginal deliveries.

Data from Washington State birth certificates from 1980-83 were used to estimate excess risk to the infant delivered via repeat cesarean section independently of any risk associated with the indication for the procedure. Using a case-control design, we compared the method of delivery of all infants with low (0-6) five-minute Apgar scores born to multiparous mothers after uncomplicated pregnancies and births to that of similar infants with a high score (7-10), frequency matched by birthweight. Of the 1,030 infants with low Apgar score, 127 (12.3 per cent) were delivered via repeat cesarean section, in contrast to 98 (9.8 per cent) of 998 controls with high Apgar score. In a regression model controlling for birthweight, gestational length, maternal age, and income the relative risk was 1.29 (95% confidence interval 0.97, 1.72). Excess risk was highest among babies of normal (2500-4000 grams) birthweight. While a number of limitations inherent in the source of data require cautious interpretation of these results, we conclude that some excess risk of low Apgar score may be associated with repeat cesarean section procedures.

Apgar Score↗
PubMed1985

Apgar scores and cerebrospinal fluid beta-endorphinlike immunoreactivity during the first day of life. Preliminary observations.

beta-Endorphinlike Immunoreactivity (BLI) was measured in sterile, bloodless samples of cerebrospinal fluid (CSF) during the first 24 hours of life in order to assess the relationship between perinatal asphyxia and endogenous opioid activity within the central nervous system. The median CSF BLI in infants with one-minute Apgar scores of 1 to 4 was 148 pg/mL (range, 96 to 171 pg/mL) and that of infants with Apgar scores of 5 to 9 was 78 pg/mL (range, 25 to 162 pg/mL). The linear regression equation correlating CSF BLI with one-minute Apgar score was y = -10.7x + 169.1. Our findings of a highly significant inverse correlation between one-minute Apgar scores and CSF BLI support the hypothesis that perinatal asphyxia is associated with increased activity of opioid systems in the central nervous system.

Apgar Score↗
PubMed2006

Admission cardiotocography versus intermittent auscultation of fetal heart rate: effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery--a systematic review.

OBJECTIVE: The aim of this review was to determine whether intrapartum admission cardiotocography (CTG) in women at low obstetric risk can improve neonatal outcome (in terms of Apgar score) and whether it is associated with an increase in the incidence of instrumental delivery and caesarean section. REVIEW METHODS: The Cochrane Library, Medline (1966-November 2005), Embase (1980-November 2005) and the PubMed were searched for randomized control trials and systematic reviews of randomized control trials. Studies were assessed for quality. Outcomes considered the neonatal Apgar score at 5 min after delivery, caesarean section and instrumental delivery. A meta-analysis of the results of the randomized controlled trials was performed. RESULTS: The pooled relative risk for having an Apgar score less than 7 points at 5 min after delivery was higher in the admission CTG group (RR 1.35, 95% CI 0.85-2.13) but it was not statistically significant. The pooled relative risks for having a caesarean section-delivery (RR 1.2 95% CI 1.00-1.41) and an instrumental delivery (RR 1.1 95% CI 1.00-1.18) were both higher in the admission CTG group. Both these were statistically significant. CONCLUSION: Intrapartum admission cardiotocography in women at low obstetric risk increases the risk of caesarean section and instrumental delivery. In addition, there is no evidence for neonatal benefit in terms of Apgar score at 5 min after delivery. A larger sample size would be needed in order to answer this important question.

Apgar Score↗
PubMed1977

Respiratory depression at birth--value of Apgar score and ventilatory measurements in its detection.

The purpose of this investigation was to determine the value of ventilatory measurements and Apgar score in the diagnosis of respiratory depression in the newborn infant. The following were the results of the determinations made in 24 neonates whose mothers had received meperidine in a total dose up to 3 mg/kg within three hours prior to delivery; Respiratory rate, 51+/-3.7/minute; tidal volume, 21.4 +/- 1.5 ml; minute ventilation, 339 +/- 24 ml/kg X minute; end tidal CO2, 40.8 +/- 1.3 mm Hg; ventilatory response to CO2, 21.8 +/- 2.7 ML/KG X minute X mm Hg PACO2. The mean Apgar score was 7.1 and 9.0 at 1 and 5 minutes, respectively. None of the determinations were indicative of respiratory depression with the exception of the slope of the CO2 response curve; it was considered to be below the normal range. No correlations existed between the CO2 response curve and any other values. It is concluded that meperidine administered to mothers in labor in the described dose will not significantly alter Apgar score, VE, VT, RR, AND PAco2 in the newborn infant. The extent of respiratory center depression could be determined only by the decreased ventilatory response to CO2.

Apgar Score↗
PubMed1999

Comparison of epidural and general anaesthesia for elective caesarean delivery according to the effects of apgar scores and acid-base status.

The objective of this study was to determine the effects of lumbar epidural anaesthesia on the Apgar score and acid-base status of the newborn. Umbilical artery blood gases were obtained in 85 singleton, term, uncomplicated pregnancies delivered by elective Caesarean section. The umbilical artery blood pH, PaCO2, PaO2 and HCO3 values and Apgar scores (1 and 5 minutes) were compared between lumbar epidural and general anaesthesia groups. General anaesthesia was used in 45 (52.9%) women and lumbar epidural anaesthesia in 40 (47.1%). Only 2 of the newborns exposed to epidural anaesthesia had umbilical artery blood pH values 7.19 or less. The mean umbilical artery blood pH was found to be significantly lower in the newborns exposed to lumbar epidural anaesthesia (p = 0.011). None of the newborns in the 2 groups were severely depressed (Apgar scores less than 4). The mean umbilical artery blood PaCO2, PaO2 and HCO3 values did not show any significant difference between the groups. In conclusion, lumbar epidural anaesthesia is associated with lower umbilical artery blood pH values, occasionally with severe fetal acidaemia.

Anesthesia, Epidural↗
PubMed2005

Brainstem auditory-evoked responses in full-term newborn infants with temporary low Apgar score.

CONCLUSIONS: No abnormalities, with the exception of maturational changes, in BAER were found during the neonatal period. The results suggest that a temporary low Apgar score is not accompanied by any significant auditory impairment. OBJECTIVE: To examine brainstem auditory function in newborn infants with a temporary low Apgar score but no clinical signs of hypoxic-ischaemic encephalopathy (HIE). MATERIAL AND METHODS: The subjects were 36 full-term infants with Apgar scores of < or =7 at 1 and/or 5 min and > or =8 at 10 min but without HIE. The brainstem auditory-evoked response (BAER) was serially recorded at click rates of 21, 51 and 91/s on Days 1, 3, 5, 7 and 30 after birth. RESULTS: On Day 1 and Days 3-5, the latencies of waves I, III and V tended to increase slightly at all click rates but did not differ significantly from normal control values. Thereafter, all latencies tended to decrease, reaching control values on Day 30. The I-V interval was similar to the control values at all click rates during the first 5 days, tended to decrease from Day 7 and did not differ from the control values on Day 30. There were no significant changes in BAER wave amplitudes at any of the click rates on any day.

Apgar Score↗
PubMed1991

Association between umbilical artery cord pH, five-minute Apgar scores and neonatal outcome.

A prospective study was conducted of 270 intrapartum patients admitted in labor to investigate the independent and combined relationships between umbilical arterial cord pH and Apgar scores and neonatal outcome. The results revealed that when assessed independently, a low 5-min Apgar score (less than 7) was associated with both NICU admission and neonatal sepsis. When categorized by both cord pH and 5-min Apgar, the majority of patients (75.9%) had both parameters normal, 20.7% had an abnormal pH (less than 7.20) and normal Apgar (greater than or equal to 7) and few patients had either both normal or an abnormal Apgar given a normal pH. Given a normal 5-min Apgar score, additional information about the cord pH did not enhance the predictability for either NICU admission or neonatal sepsis. Neonates with both an abnormal pH and 5-min Apgar had the highest incidence of NICU admission. For all neonates, the presence of meconium greatly increased the likelihood of being admitted to the NICU.

Acidosis↗
PubMed1989

Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores.

A prospective study of the relationships among fetal heart rate pattern, meconium staining of the amniotic fluid, umbilical cord artery pH, and Apgar score was carried out in 1219 consecutive births. Interpretable cardiotocogram patterns and cord arterial pH and blood gas analysis were obtained in 698 cases. The sensitivity of an abnormal cardiotocogram at any time for acidosis (more than 1 SD below the mean, pH less than 7.17) was 80%, and for severe acidosis (more than 2 SDs below the mean, pH less than 7.085) was 83%. However, the predictive value was low, and 32% of fetuses had an abnormal cardiotocogram but no acidosis. If only cardiotocogram abnormality in the first stage of labor was considered, sensitivity was still 47% for acidosis and 67% for severe acidosis, and the false-positive rate was reduced to only 14%. We attempted to improve the prediction of acidosis by including meconium staining of the amniotic fluid, but 65% of the variation in umbilical cord artery pH and 72 and 86% of the variation in 1- and 5-minute Apgar scores, respectively, remained unexplained. In light of these poor correlations, the current practice of considering cardiotocogram abnormality, meconium staining of the amniotic fluid, acidosis, and low Apgar scores as indicating one single disorder, "fetal distress," is not valid.

Acidosis↗
PubMed1987

The relationships among the fetal biophysical profile, umbilical cord pH, and Apgar scores.

The relationships among the fetal biophysical profile, umbilical cord blood pH, and Apgar scores were investigated in 124 patients undergoing cesarean section before the onset of labor. Based on a standard for the diagnosis of fetal acidosis of an umbilical cord arterial pH less than 7.20, the sensitivity, specificity, and positive and negative predictive values of the fetal biophysical profile score were 90%, 96%, 82%, and 98%, respectively. When the combination of a nonreactive nonstress test and absent fetal breathing was used as the "abnormal test," the sensitivity, specificity, and positive and negative predictive values were 100%, 92%, 71%, and 100%, respectively. The efficacy of the fetal biophysical profile to indicate fetal acidosis was found to be superior to the 1- and 5-minute Apgar scores in sensitivity and positive predictive value. These data suggest that the biophysical profile is very accurate in the identification of the fetus with acidemia. The first manifestations of fetal acidosis are nonreactive nonstress testing and loss of fetal breathing; in advanced acidemia fetal movements and fetal tone are compromised. A new protocol of antepartum fetal evaluation is suggested based on individual biophysical components rather than the score alone.

Acidosis↗
PubMed1979

[Investigation on the influence of a tocolytic treatment of pregnant women with diazepam and fenoterol on the bilirubin levels and apgar score of newborn (author's transl)].

In a retrospective study of 2618 pregnant women we examined the influence of diazepam monotherapy as well as the combination of diazepam and fenoterol on the bilirubin concentrations and Apgar scores of the newborn children. In the diazepam-treated group 17-27% of the newborns showed Apgar scores of 6 or less. In the group treated with diazepam and fenoterol, 66-68% of the newborn had Apgar scores of 6 or less. The effect of diazepam on the bilirubin levels appears to depend on the dose and duration of the diazepam treatment: low, short term diazepam doses cause a slight bilirubin increase, while higher diazepam doses cause a reduction of the bilirubin levels. Following the combination therapy of diazepam and fenoterol a significant number of the infants developed neonatal jaundice. Due to the fact that following the combination therapy the diazepam concentration of the newborns were higher than following the monotherapy, we ascribe the greater frequency of the low Apgar values and also possibly the larger bilirubin increase to the higher diazepam concentration caused by fenoterol.

Apgar Score↗
PubMed1992

Methods of resuscitation in low-Apgar-score newborn infants--a national survey.

The incidence, treatment and immediate course in infants with postnatal apnoea were studied. Information on all infants born in Sweden in 1985 with a low Apgar score (3 or less at 1 min or 6 or less at 5 min) was collected from the midwife and from the baby's chart. Of the 97,648 live births, 1633 (1.7%) had a low Apgar score. The risk increased with decreasing birthweight and with severe malformations. Before delivery, 19% of the low-Apgar-score infants were not expected to require resuscitation. Eighty percent of the ventilated infants were satisfactorily ventilated by bag and mask; the remainder were intubated. Of the ventilated infants, 78% developed spontaneous breathing within 10 min after birth and 89% within 20 min. Routine intubation or administration of buffer in cases of postnatal asphyxia had no influence on the time to onset of regular spontaneous breathing.

Apgar Score↗
PubMed1998

An Apgar score of three or less at one minute is not diagnostic of birth asphyxia but is a useful screening test for neonatal encephalopathy.

OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.

Apgar Score↗
PubMedDate not supplied

Umbilical plasma erythropoietin, hematocrits and their relationship to umbilical arterial blood gas, Apgar score and perinatal risk factors.

This study was to assess the relationships of umbilical plasma erythropoietin (EPO) and hematocrit (Hct) levels with the umbilical arterial blood gas data, 1- and 5-minute Apgar scores, and other perinatal risk factors in 51 infants born at our hospital. Mean umbilical arterial pH, PCO2, PO2, base excess, oxygen saturation and Hct were not significantly different in infants of appropriate for gestational age (AGA) (n = 26), large for gestational age (LGA) (n = 6) and small for gestational age (SGA) (n = 19). The median umbilical plasma EPO levels in AGA, SGA, and LGA infants were 26.06 mU/ml, 28.81 mU/ml and 25.20 mU/ml respectively. Mean levels of EPO were comparable among the groups. Infants born by vaginal route who were SGA, LGA, or associated with maternal preeclampsia, maternal anemia and intrauterine hemolysis had significantly higher EPO levels than the other infants. While infants with heavy meconium staining (n = 5) had significantly lower umbilical PO2 than those who without it (n = 35), there was no difference in EPO and Hct levels among heavy, light and no meconium staining infants. There was poor correlation between the plasma EPO, Hct levels, Apgar scores and blood gas data. We conclude that umbilical EPO and Hct levels did not correlate significantly with Apgar scores, and umbilical blood gas data, neither were they associated with intrauterine growth patterns and meconium staining. High risk infants, especially those delivered by vaginal route had significantly higher EPO levels. The significance of high umbilical EPO values and their relation to the neurological outcome warrants further study.

Apgar Score↗
PubMedDate not supplied

Predicting infant apgar scores.

This study identified psychologic and sociologic phenomena that affect a woman during pregnancy which, when associated with physical factors, result in poor neonatal outcome for the infant, as measured by the Apgar score at five minutes after birth. The Utah Test Appraising Health (UTAH) was administered to 51 pregnant women during the second or third trimester of pregnancy. Data measuring maternal and infant outcomes were collected postdelivery. A significant correlation was found between maternal stress up to six months before administration of the UTAH questionnaire and the five-minute infant Apgar score (r = -.2787, p less than or equal to .05). The stress score was combined with past pregnancy complications, pregnancy symptoms during the first and third trimesters, and illness-proneness in a regression equation. The total multiple correlation coefficient was .8979, with stress X past pregnancy complications contributing most to the prediction equation. When stress and past pregnancy complications were controlled, the partial correlation value was -.8001. The data were consistent with the hypothesis that stress during pregnancy is an activator of physical illness processes in the mother, and, when combined with these variables, is related to neonatal outcome, as measured by the infant Apgar score at five minutes.

Adaptation, Psychological↗