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PubMed1998

Interaction between maternal cigarette smoking and Apgar scores in predicting offending behavior.

Research has shown that various perinatal conditions increase the likelihood of offending behavior; however, results have been mixed, but interactions among perinatal risk factors in predicting offending behavior have been neglected. The purpose was to examine the interaction of maternal cigarette smoking during pregnancy and 1-min. Apgar scores at birth in predicting individuals' later offending behavior. The longitudinal data set was taken from the Philadelphia portion of the Collaborative Perinatal Project and consisted of 832 inner-city, African-American youths. A logistic regression analysis indicated that the combined effect of maternal cigarette smoking and low Apgar scores had a significant influence in predicting offending behavior, whereas the independent effects of the component variables did not.

Adolescent↗
PubMed1998

Predictors of neonatal resuscitation, low Apgar scores, and umbilical artery pH among growth-restricted neonates.

OBJECTIVE: To identify risk factors associated with poorer immediate neonatal outcomes among growth-restricted neonates. METHODS: Records of all 530 growth-restricted neonates born between January 1989 and February 1995 were reviewed. Outcomes included resuscitation measures, Apgar scores, and umbilical blood gas values. Neonates were assigned to one of six anesthetic groups, and outcomes were compared. Predictors of poorer outcomes were examined using logistic and linear regression. RESULTS: Neonates exposed to general anesthesia were more likely to be intubated (37.9% versus 4.1%, P < .001, Pearson chi2) and had lower mean 1- (4.0 versus 7.0) and 5-minute (6.5 versus 8.4) Apgar scores (P < .01, Scheffé) than those in all other anesthetic groups. They also had significantly lower umbilical artery (UA) pH values than neonates who received nalbuphine, epidural, or no anesthesia (7.21 versus 7.28, 7.26, 7.29, respectively; P < .01, Scheffé). Factors that significantly and independently predicted intubation among all neonates included exposure to general anesthesia (odds ratio [OR] 4.1; 95% confidence interval [CI] 1.9, 8.9) and lower infant weight (OR 10.1 per kg decrease; CI 5.1, 20). Factors predicting UA pH at most 7.15 included preeclampsia (OR 3.0; CI 1.5, 5.9) and older maternal age (OR 1.3 per 5 years; CI 1.02, 1.64); vertex delivery (OR 0.5; CI 0.2, 0.9) was protective. Factors predicting a 5-minute Apgar less than 7 were meconium (OR 1.5 per category going from none to terminal to light to heavy; CI 1.04, 2.3), general anesthesia (OR 6.9; CI 2.6, 18.2), lower infant weight (OR 16.5 per kg decrease; CI 7.8, 34.5), and vaginal breech delivery (OR 7.0; CI 1.8, 28.6); cesarean delivery (OR 0.2; CI 0.08, 0.66) was protective. Spontaneous vertex delivery raised the UA pH, and preeclampsia, amnioinfusion, breech delivery, and general anesthesia significantly and independently lowered the UA pH among all neonates. For infants delivered by cesarean, "fetal distress," preeclampsia, previous spontaneous abortion, failed forceps use, and nalbuphine significantly and independently predicted lower UA pH. CONCLUSION: Risk factors for poorer immediate neonatal outcomes among growth-restricted neonates include preeclampsia, fetal distress, breech delivery, forceps use, nalbuphine during labor, lower infant weight, and general anesthesia.

Analgesics, Opioid↗
PubMed1987

Plasma catecholamine levels in preterm infants. Effect of birth asphyxia and Apgar score.

Catecholamine levels were measured in cord arterial blood from preterm infants. Relatively lower catecholamine levels were found in the preterm infants than in term infants, although no significant correlation was found between noradrenaline and adrenaline levels and either gestational age or birthweight. Significantly higher catecholamine levels were found after labour. Preterm females had significantly higher catecholamine levels than boys after asphyxia and tended also to have higher catecholamine levels without asphyxia, although not significant. Catecholamine levels were also significantly elevated in those infants with a low Apgar score (less than 7 at 5 min) and those who were acidotic (cord arterial pH less than 7.25). A good correlation was found between a low Apgar score and the presence of acidosis.

Apgar Score↗
PubMed1994

Emergency cesarean section: the effect of delay on umbilical arterial gas balance and Apgar scores.

BACKGROUND: We wanted to conduct a prospective study on the dynamics of emergency cesarean section (ECS) in terms of fetal survival and morbidity. METHODS: The study covered 101 cases of ECS in Helsinki City Hospital, in which the time of alarm, the starting time of the operation, the time of birth, the umbilical arterial gas values, and Apgar scores were known. This group consisted of 60 cases with the operating team in the hospital (group 1) and 41 cases with the team on call (group 2). Means of the parametric variables were compared by the analysis of variance using separate or pooled t-tests after Levene's test of variances. Difference between the rate of adverse outcome (dead or handicapped) in each group was calculated using chi-square test. RESULTS: In group 1, the time between the clinical decision and the time of delivery (mean +/- s.e.mean) was 13.5 +/- 0.7 min, in group 2, 23.6 +/- 0.9 min. The groups did not differ in terms of birthweight, placental weight, Apgar scores, and umbilical arterial gas values, except for pO2. The mean pO2 in group 1 was lower (1.9 +/- 0.1 kPa) than in group 2 (2.5 +/- 0.2 kPa). p = 0.0023. In group 2, one infant was handicapped by hypoxic ischemic encephalopathy and three fetuses had died in utero. The rate of survivors was significantly higher when the operating team was in hospital (p = 0.05). CONCLUSION: The risk of fetal loss is evident when the operating team is on call outside the hospital, at least if the alarm to operation interval exceeds 20 minutes. The present study suggests that 24-hour services of anesthesia and operating theater personnel are crucial for optimal management of emergent situations in the delivery room.

Adult↗
PubMed1997

Preterm birth and cerebral palsy. Predictive value of pregnancy complications, mode of delivery, and Apgar scores.

BACKGROUND: Preterm infants are at 8 times higher risk than term infants for pre- and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth-related risk factors on cerebral palsy in preterm infants. METHODS: In a register-based study, 175 preterm singleton infants with cerebral palsy, born in 1982-86, were compared with 687 controls matched by gestational age and year of birth. RESULTS: Statistically significant higher rates in cases were found in parity > or = 3 (22% vs. 16%, p < 0.05), Cesarean section (67% vs. 56%, p < 0.01), and low Apgar scores at 1 minute (45% vs. 36%, p < 0.05). By multivariate analyses, two variables remained statistically significant: parity > or = 3 (adjusted OR = 1.53 (95% CI 1.00-2.34), p < 0.05) and Cesarean section (adjusted OR = 1.57 (95% CI 1.07-2.32), p < 0.05). CONCLUSIONS: Pregnancy complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited.

Adult↗
PubMed2006

How often is a low 5-min Apgar score in term newborns due to asphyxia?

OBJECTIVE: To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia. STUDY DESIGN: A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed. RESULTS: After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001). CONCLUSIONS: In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.

Acidosis↗
PubMedDate not supplied

Apgar score.

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Apgar Score↗
PubMed2006

The Apgar score.

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Apgar Score↗
PubMed1986

Apgar scores and asphyxia. Results of a study and proposal for a clinical grading system.

The Apgar score (AS) was devised in 1953 as a simple system for classifying neonatal condition at 1 minute and was later modified to include status at 5 minutes. However, studies have documented pitfalls, e.g. a poor correlation between AS and acid-base status. We studied 35 infants born at term. ASs were assigned by two nurses not involved in the delivery, and antepartum and postpartum events were noted. We confirmed the following: (i) labour ward staff tend to overestimate ASs; (ii) there is a poor correlation between the AS and acid-base status; and (iii) the labour ward staff's decision to resuscitate with intermittent positive-pressure respiration (IPPR) correlates with the AS but not with blood gas status. Infants with initially low ASs and/or a brief requirement for IPPR may be recorded by medical or nursing staff as being asphyxiated at birth. Our results show that low ASs may be associated with normal acid-base status and vice versa. In order further to define asphyxia, we therefore propose that a grading system which incorporates clinical data and the AS be used. Use of such a system would facilitate inter-area comparisons of grades of asphyxia encountered, efficacy of intervention programmes and developmental outcome of asphyxiated neonates.

Apgar Score↗
PubMedDate not supplied

Apgar score and blood coagulation factors.

Blood coagulation tests were performed in 93 newborn infants with different Apgar score at the 1st and 5th minutes of life. The laboratorial determinations were periodically performed at 0, 24 and 48 hours of life. The following tests were performed: bleeding time, whole blood clotting time, prothrombin time, kaolin-cephalin clotting time, thrombin time, dosage of factors I, V, VIII and X, clot retraction, platelet count, englobulin lysis time and the tourniquet test. Immediately after birth, the mean values of the blood coagulation factors were significantly different among the groups, with the exception of the whole blood clotting time and the platelet count. Those differences were due to the presence of the more depressed neonates. Although these results could indicate some degree of hepatic damage, it was apparent that an activation of the blood coagulation mechanisms took place, leading to a consumption coagulopathy. The infants who died (10) presented clinical and laboratorial data suggestive of disseminated intravascular coagulation (DIC). Necroscopic findings of microthrombosis in the liver and in the central nervous system were diagnosed in two infants.

Apgar Score↗
PubMed1993

Caesarean section anaesthesia and the Apgar score.

Retrospective comparison of epidural and general anaesthesia by a multivariate analysis of 1 and 5 minute Apgar scores did not show that general anaesthesia improves operating conditions for Caesarean section or reduces fetal trauma for preterm and term infants.

Analysis of Variance↗
PubMed2004

Low Apgar scores and the definition of birth asphyxia.

Nonreassuring fetal heart rate patterns, prolonged labor, meconium-stained fluid, a low 1-minute Apgar score, and mild to moderate acidemia have no predictive value for long-term neurologic injury without signs of encephalopathy and seizures. It is important to provide proper resuscitation, support infants, and allow time for evaluation. We have time and the tools to provide fairly predictive information to the families. It is important to use this knowledge wisely in communicating honestly with families, because difficult decisions undoubtedly will arise.

Apgar Score↗
PubMed1995

Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores.

Serial ultrasound scans and conventional and diffusion weighted magnetic resonance imaging (MRI) were performed on 16 neonates who presented with seizures. The Apgar scores were normal and subsequently no metabolic or infective cause could be found. The aim of the study was to evaluate the extent to which early sequential imaging can elucidate the cause of seizures in apparently neurologically normal infants. Fourteen of the infants had haemorrhagic or ischaemic lesions on MRI and these were detected by ultrasound scanning in 11. Early ultrasound scanning detected the haemorrhagic lesions but the ischaemic lesions were often not seen until the end of the first week of life. Early MRI, however, was able to detect all the ischaemic lesions. The evolution of the insult could be timed by using serial ultrasound scans and a combination of diffusion weighted and conventional MRI during the first week of life, confirming a perinatal insult even in the absence of fetal distress. Although the aetiology of these lesions remains obscure, serial ultrasound scans will detect the presence of cerebral lesions in neonates presenting with isolated seizures but additional MRI sequences will give better definition on type, site, and extent of the pathology.

Apgar Score↗