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PubMed2004

The effect of blood gas and Apgar score on cord blood cardiac troponin I.

OBJECTIVES: The aims of this study were to (a) establish a reference range for cardiac troponin I (cTnI) in the cord blood of healthy infants, and (b) investigate the effect of Apgar score, cord blood gas, gestational age, and creatine kinase (CK) and creatine kinase MB (CK-MB) fraction levels on cord blood cTnI levels. METHODS: 112 perinatal hypoxic and 84 control newborns without perinatal hypoxia were enrolled in this study. Cord blood samples were collected from the babies for arterial blood gas analysis, cTnI, CK and CK-MB measurements. Gestational age, birth weight, sex, Apgar score and history of fetal distress were recorded. Hypoxic ischemic encephalopathy (HIE) group, hypoxic but without HIE group and control groups were identified according to clinical observations during the first 72 h in the newborn unit. RESULTS: HIE and perinatal hypoxic without HIE groups had a significantly higher cord blood cTnI level according to the control group (1.8 ng/mL (0-13), 0 ng/ml (0-1.1) and 0 ng/ml (0-0.3) respectively). Cord blood cTnI level did not have a correlation with birth weight and gestational age (r = -0.02, p > 0.05 and r = 0.08, p > 0.05 respectively). Cord blood cTnI level also had a negative correlation with pH, bicarbonate, base deficit, and Apgar score (r = -0.40, p < 0.001; r = -0.39 p < 0.001; r = -0.45 p < 0.001; r = -0.41, p < 0.001) respectively). Cord blood cTnI level showed a positive correlation with CK and CK-MB levels (r = 0.45, p < 0.001 and r = 0.37, p < 0.001 respectively). Receiver operator curve analysis revealed that the most sensitive factor for prediction of perinatal hypoxia is cord cTnI value [area under curve = 0.929]. The optimal cut-off value of cord cTnI was 0.35 ng/ml for hypoxia. CONCLUSION: cTnI levels in the cord blood are not affected by gestational age and birth weight. cTnI together with CK and CK-MB has been found to be elevated in hypoxic infants compared to normal infants. Therefore cTnI may be an indicator for perinatal hypoxia in neonates.

Algorithms↗
PubMed1978

Correlation between foetal pH, cord blood glucose level and Apgar score in a foetal intensive care unit--preliminary report.

The foetal pH (the term 'foetal pH' is used for the pH of foetal capillary blood obtained by making a small incision in the foetal scalp or buttocks) and the umbilical cord blood glucose levels in pregnant women with foetal distress were estimated in 19 babies as a prospective study in Ile-Ife, Nigeria. The Apgar Scores on delivery were also estimated. There was a significant correlation coefficient between foetal pH and Apgar Score r = 0.38 and the coefficient of correlation between umbilical artery blood glucose and foetal pH was 0.08. Estimation of the pH of blood taken from the foetal scalp is now well established as a diagnostic measure in the early diagnosis of foetal distress due to hypoxia. The results obtained from this small series of nineteen patients highlights the importance of the estimation of foetal pH, blood glucose and the Apgar Score. This is the first account in Ile-Ife, Nigeria.

Apgar Score↗
PubMed1980

Correlation of meconium-stained amniotic fluid, early intrapartum fetal pH, and Apgar scores as predictors of perinatal outcome.

A prospective study was undertaken to determine if the passage of meconium during the early intrapartum period (cervical dilatation 3 cm or less), the type of meconium passed (thick versus thin), and fetal pH values could be correlated with Apgar scores as a predictor of neonatal outcome. One hundred seventy-seven patients had meconium-stained amniotic fluid and a cervical dilatation of 3 cm or less at admission. Group 2 (thick meconium) had significantly lower 1- and 5-minute Apgar scores, lower scalp pH values, and increased risk factors, such as prolonged pregnancy, small-for-gestational-age fetus, and fetal heart rate abnormalities. Group 2 (thin meconium) and the control group (nonmeconium) appeared to have no increased associated risks. Thick meconium as a single variable appeared to be the most significant factor influencing fetal outcome; however, if an associated fetal heart rate abnormality was present, perinatal morbidity was greatly increased as indicated by fetal acidosis and lower 1- and 5-minute Apgar scores. It thus appears that early passage of thick meconium does correlate with fetal outcome and increased perinatal morbidity. The significance of meconium passage is discussed and a modern obstetric management scheme for these high-risk patients is presented.

Acidosis↗
PubMed1979

Underlying disorders responsible for the neonatal deaths associated with low Apgar Scores.

Data from a large study were used to determine the frequency of fatal disorders associated with low Apgar scores. 5-min scores had the best correlation with mortality rates. Death rates were more than ten times greater with abnormal than with normal 5-min scores. This difference was only 3-fold for 1-min values. Amniotic fluid infections were responsible for nearly half of the deaths in preterm and 24% of the deaths in term neonates with 5-min Apgar scores 0--6. The respective values for disorders that cause antenatal hypoxia were 25 and 24% and for major congenital anomalies, 7 and 28%.

Abruptio Placentae↗
PubMed1989

Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction.

Imprecise diagnosis of birth asphyxia coupled with uncertainties about causal factors for neurologic abnormalities in the newborn have greatly fueled the current litigation crisis in obstetrics. Our goal was to more precisely define birth asphyxia based on fetal condition as measured by umbilical artery blood pH, Apgar scores, and neurologic condition of newborns. We selected for study 2738 patients with singleton pregnancies with cephalic presentations who were delivered of infants at term to avoid complications such as prematurity, which may affect infant outcome independent of birth condition. The basis for study of these particular patients were defined criteria for high risk and an indicated arterial cord pH value. A total of five infants demonstrated cerebral dysfunction as evidenced by seizures during the neonatal period. Infection was linked to seizures in three of these infants; one infant had neonatal asphyxia and only one infant's clinical course could be attributed solely to birth events (uterine rupture). Stratification of umbilical artery blood pH values, Apgar scores, and combinations of these dependent variables in relation to newborn clinical outcomes revealed that infants must be severely depressed at delivery before birth asphyxia can be reliably diagnosed. Such depression includes Apgar scores less than or equal to 3 at 1 and 5 minutes plus umbilical artery pH values less than 7.00.

Acid-Base Equilibrium↗
PubMed1988

The effects of magnesium sulfate therapy on Apgar scores.

When intravenous magnesium sulfate is infused in women with pregnancy-induced hypertension, the hypermagnesemia does not result in lower Apgar scores. The mean maternal serum and cord magnesium levels at delivery were 5.3 +/- 0.72 and 5.3 +/- 1.1 mEq/dl, respectively. The most common negative Apgar score was assigned for color, not for muscle tone.

Apgar Score↗
PubMedDate not supplied

Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms.

UNLABELLED: The objective of the study was to find associations between obstetric complications (OCs) history and schizophrenia course and symptoms. We analysed the obstetric and psychiatric history of 50 DSM IV schizophrenic subjects who experienced their first schizophrenia episode in adolescence, and 30 healthy controls. Obstetrical data and Apgar scores were obtained from medical records and evaluated with the Lewis and Murray Scale. Based on patients' documentation [including longitudinal evaluation with Positive and Negative Syndrome Scale (PANSS)] the symptom profile and the course of schizophrenia were determined. RESULTS: we distinguished two major groups of patients: with prominent negative and prominent positive symptoms. Schizophrenics with prominent negative symptoms and a chronic schizophrenia course had significantly more definite OCs and lower Apgar scores than patients with prominent positive symptoms and controls. Subjects who had a positive OCs history were more than four times likely to develop schizophrenia in adolescence than those without such a history (OR=4.64; 95% CI=1.29-17.51) with the likelihood of developing schizophrenia with prominent negative symptoms especially high (OR=7.31; 95% CI=1.80-29.65). An Apgar score of between 0 and 3 after birth was associated with an increased risk for developing schizophrenia (OR=2.25; 95% CI=0.56-9.12), especially with prominent negative symptoms (OR=3.71; 95% CI=0.84-16.32). The findings support the hypothesis of a role of OCs in developing early-onset schizophrenia and suggest the associations of the OCs history with a specific symptoms profile (prominent negative symptoms) and a chronic course of schizophrenia.

Adolescent↗
PubMed1981

Effect of maternal cigarette smoking on Apgar scores.

As shown in a total of 43,492 live-born singleton infants, the proportion of low and depressed Apgar scores is related to the extent of maternal cigarette usage during pregnancy. In particular, the three-pack level of smoking (41 to 60 cigarettes per day) is reflected in a near-quadrupling of low and depressed one-minute and five-minute Apgar scores in both blacks and whites and also after exclusion of prematurely born infants.

Apgar Score↗
PubMedDate not supplied

Out-of-hospital births, U.S., 1978: birth weight and Apgar scores as measures of outcome.

An examination of 1978 natality data for the United States disclosed that low birth weight was less common among 30,819 infants born out of hospital than among 3,294,101 infants born in hospital in that year. When controls were applied for birth attendant, infants' race, and mothers' education, age, nativity, and parity, the data revealed that white, well-educated women between 25 and 39 years of age, who were having their second babies and were attended by midwives out of hospital, were at least risk of bearing low birth weight infants. The incidence rate of low birth weight babies was lower for midwife-attended births in every category examined. For college-educated white women, for example, the incidence rate was 2.0 percent among those attended by midwives, 4.6 percent among those giving birth in hospital, and 3.6 percent among those whose out-of-hospital deliveries were attended by physicians. Apgar scores for babies born both in and out of hospital were also studied but, because of inconsistent reporting, were given less attention. Excellent (9-10) Apgar scores were more common among babies born out of hospital than among those born in hospital (63 percent compared with 49 percent), particularly for out-of-hospital births attended by physicians. At least with respect to birth weight and Apgar scores, the claim that out-of-hospital births are inherently more dangerous than hospital births receives no support from these data. The findings also suggest the need for further refinement of vital statistics categories to permit the analysis of distinctions between births attended by certified nurse-midwives and those attended by lay midwives, as well as differences between births at home and those in alternative birth centers.

Adolescent↗
PubMed1985

The Apgar score: is it enough?

One thousand thirty-two neonates were evaluated with umbilical venous and arterial blood samples drawn at delivery for assessment of pH, PO2, PCO2, and base deficit. These values were statistically correlated with Apgar scores in all of the neonates studied. Infants were divided into Apgar groupings (group A, greater than or equal to 7 at one and five minutes; group B, less than 7 at one minute, greater than or equal to 7 at five minutes; group C, less than or equal to 7 at both one and five minutes). Generally, umbilical artery and umbilical venous data were parallel. The differences in means for pH, PO2, PCO2, and base deficit was significant when group A was compared with group B in both umbilical artery and umbilical venous data. However, a severe degree of biochemical disturbance must take place before significant association with neonatal depression can be made. It appears that umbilical blood biochemical data are related to fetal metabolic status before birth but only modestly influence the one-minute Apgar score.

Acid-Base Equilibrium↗
PubMed1998

Umbilical cord encirclements and Apgar scores.

OBJECTIVE: To establish the relative influence of umbilical cord encirclements versus fetal growth restriction in determining fetal outcome. METHODS: Twelve thousand and thirty-nine singleton births were studied. The number of cord encirclements were noted. Fetal growth restriction was measured as standard deviations from gestational weight. Fetal outcome was determined by using Apgar scores after 5 minutes. RESULTS: For growth restricted babies, Apgar 5 was not affected by the presence of encirclements when corrected for the level of FGR. Only for infants larger-for-date did the encirclements affect their Apgar score. CONCLUSION: The poorer outcome for babies with cord encirclements and fetal growth restriction is due to the accompanying level of growth restriction.

Apgar Score↗
PubMed1987

The effect of initial Apgar score on the birthweight-specific survival of the very low-birthweight infant.

Gestational age (GA) and birthweight (BW) specific neonatal survival statistics were generated to examine the possible effect of one-minute Apgar score on outcome in very low birthweight (VLBW) infants. BW-specific and GA-specific survival is enhanced when the one-minute Apgar score is 4 or more. The route of delivery seems to matter little, although the cesarean section rate is higher for VLBW infants. The data suggest that preconceived notions about adverse outcome for this group of infants could be improved by delivery in better condition. Similarly, our approach for using BW- and GA-specific outcome, which includes condition at birth, can provide a more useful basis for comparing between different populations, allowing for some assessments to be made concerning the quality of care.

Apgar Score↗
PubMed2001

[Contribution of Soranus of Ephesus on Apgar score].

Soranus of Ephesus was a famous gynecological physician in Roman times and one of the pioneers of gynecology, pediatrics and so on. The contribution of Soranus on Apgar score was researched by comparing Soranus critical and Apgar score of evaluation system of newborn infant.

Greece, Ancient↗
PubMed1986

Accuracy of Apgar score and arterial cord-blood pH in diagnosis of perinatal brain-damage assessed by CK-BB isoenzyme measurement.

This study was carried out on 45 newborns to evaluate the accuracy of 1 minute Apgar score and umbilical arterial pH for prediction of the risk of perinatal brain damage. Using a new and very sensitive method for CK-BB determination, which is considered a good indicator of brain damage, CK-BB was used as reference. Patients with low Apgar score at one minute of life had significantly higher cord blood CK-BB values than the control group (p less than 0.01). No difference was found between the control group and the group with umbilical cord blood acidosis (p less than 0.2).

Apgar Score↗
PubMed1985

Effects of electronic fetal monitoring on rates of early neonatal death, low Apgar score, and cesarean section.

Using data from the University Hospital in Odense, Denmark, we have studied the effects of electronic fetal monitoring on rates of early neonatal death (death of liveborn within first week of life), low five-minute Apgar score (less than 7), and cesarean section. Approximately 22 000 births occurring in 1974 - 82 were studied, of which 13% were electronically monitored. Monitoring was significantly associated with an elevated cesarean rate in low-risk labors and certain high-risk labors, but appeared not to increase the cesarean rate in all high-risk labors. In high-risk labors, monitoring was associated with an approximate 40% reduction in rates of low Apgar score and early neonatal death, but neither reduction was statistically significant. The associations of monitoring with elevated cesarean rate declined significantly over the study period. These results accord closely with studies conducted in the United States, indicating that monitoring is of benefit in high-risk labors, but leads to excessive cesarean deliveries in low-risk labors. Our study additionally indicates that the effect of monitoring on the cesarean rate has been declining over time.

Adult↗
PubMed2003

Spinal and general anaesthesia for emergency caesarean section: effects on neonatal Apgar score and maternal haematocrit.

This is a prospective comparative study to determine the effect of the type of anaesthesia used for emergency Caesarean section on neonatal and maternal outcome. The patients were recruited into the study after being given either general or spinal anaesthesia. Neonatal outcome was assessed using Apgar scores and need for respiratory assistance at birth. Maternal outcome was assessed using the difference between pre- and post-operative packed cell volumes (PCV), need for blood transfusion and estimated blood loss. The groups were matched for pre-existing risk factors. Apgar scores at 1 and 5 minutes were found to be significantly lower for the general anaesthesia group (GA) than the spinal anaesthesia group (SA) and need for respiratory assistance was greater for the GA group. Difference between pre- and post-operative PCV and need for blood transfusion were also significantly greater in the GA group. This study confirms that the current practice of spinal anaesthesia for Caesarean section in the Lagos University Teaching Hospital is a good one, but further studies need to be done to assess other outcome variables.

Adolescent↗