Five-minute Apgar score as a marker for developmental vulnerability at 5 years of age

This study aimed to evaluate the association of the five-minute Apgar score and neurodevelopmental outcomes in children by taking the entire range of Apgar scores into account. Data from the Australian Longitudinal Study of Women’s Health (ALSWH) and Mothers and their Children’s Health (MatCH) study were linked with Australian state-based Perinatal Data Collections (PDCs) for 809 children aged 8−66 months old. Generalized estimating equations were used to model the association between the five-minute Apgar scores and neurodevelopmental outcomes, using STATA software V.15. Of the 809 children, 614 (75.3%) had a five-minute Apgar score of 9, and 130 (16.1%) had an Apgar score of 10. Approximately 1.9% and 6.2% had Apgar scores of 0−6 and 7−8, respectively. Sixty-nine (8.5%) of children had a neurodevelopmental delay. Children with an Apgar score of 0−6 (AOR = 5.7; 95% CI: 1.2, 27.8) and 7−8 (AOR = 4.1; 95% CI: 1.2, 14.1) had greater odds of gross-motor neurodevelopment delay compared to children with an Apgar score of 10. Further, when continuously modelled, the five-minute Apgar score was inversely associated with neurodevelopmental delay (AOR = 0.75; 95% CI: 0.60, 0.93). Five-minute Apgar score was independently and inversely associated with a neurodevelopmental delay, and the risks were higher even within an Apgar score of 7−8. Hence, the Apgar score may need to be taken into account when evaluating neurodevelopmental outcomes in children.

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PLASMA CORTICOSTEROIDS IN INFANTS WITH THE RESPIRATORY DISTRESS SYNDROME

PEDIATRICS ◽

10.1542/peds.52.6.782 ◽

1973 ◽

Vol 52 (6) ◽

pp. 782-787 ◽

Cited By ~ 1

Author(s):

Melvin Baden ◽

Charles R. Bauer ◽

Eleanor Colle ◽

George Klein ◽

Apostolos Papageorgiou ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Premature Infants ◽

Negative Correlation ◽

Apgar Score ◽

Distress Syndrome ◽

Serum Concentrations ◽

Response To Stress ◽

Minute Apgar Score

Plasma total corticosteroid concentrations were measured in 44 premature infants with the respiratory distress syndrome (RDS). Further assay of serum concentrations of cortisol, cortisone, corticosterone, corticosterone sulfate, and 11-deoxycorticosterone sufate was carried out in 24 of these infants and in 10 healthy, nonstressed premature controls. Infants with RDS had higher concentrations of cortisol (22.1±4.3µg/100 ml) and corticosterone sulfate (7.7 ± 0.8 µg/100 ml) than control infants (6.6 ± 0.8 µg/100 ml, 1.2 ± 0.3 µg/100 ml, and 4.2 ± 0.4 µg/100 ml, respectively). A significant correlation was found with the five-minute Apgar score (negative correlation, p = 0.005) and a possible correlation with the A-aDO2 gradient. Among premature infants with RDS, those of 32 weeks' gestation or less had higher concentrations of cortisol (28.3 ± 23.6 µg/100 ml) and corticosterone (3.9 ± 2.7 µg/100 ml) than those of more than 32 weeks (11.5 ± 5.4 µg/100 ml and 1.7 ± 0.7 µg/100 ml, respectively), suggesting either elevated response to stress or a diminished ability to metabolize these compounds.

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Are the King County SIDS Data Generalizable?

PEDIATRICS ◽

10.1542/peds.92.2.304a ◽

1993 ◽

Vol 92 (2) ◽

pp. 304-304

Author(s):

JOEL E. HAAS

Keyword(s):

Growth Velocity ◽

Apgar Score ◽

Statistical Significance ◽

King County ◽

Circular Reasoning ◽

Minute Apgar Score ◽

Do So

In Reply.— Dr Brooks aptly cautions that one may not appropriately base intergroup comparisons on criteria used to define the groups. We specifically indicated our intention not to do so in pointing out the folly of such "circular reasoning" in the manuscript's penultimate paragraph. We do not cite the statistical significance of SIDS intergroup differences. We do wish to emphasize the lack of differences in 5-minute Apgar score and growth velocity when the "classic SIDS" group is compared to appropriate controls.

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Neonatal Seizures II. A Multivariate Analysis of Factors Associated with Outcome

PEDIATRICS ◽

10.1542/peds.70.2.177 ◽

1982 ◽

Vol 70 (2) ◽

pp. 177-185 ◽

Cited By ~ 3

Author(s):

E. David Mellits ◽

Kenton R. Holden ◽

John M. Freeman

Keyword(s):

Multivariate Analysis ◽

Apgar Score ◽

Onset Time ◽

Adverse Outcomes ◽

Neonatal Seizures ◽

Prediction Of Outcome ◽

Factors Associated ◽

Early Predictors ◽

Neurologic Sequelae ◽

Minute Apgar Score

A multivariate analysis of perinatal events occurring in infants with neonatal seizures who were enrolled in the National Collaborative Perinatal Project allowed prediction of outcome. This prediction of death or of mental retardation, cerebral palsy, or epilepsy was empirically confirmed 64% to 83% of the time. In an infant with neonatal seizures, a five-minute Apgar score of less than 7, the need for resuscitation after 5 minutes of age, the onset time of the seizures, and a seizure lasting more than 30 minutes are the best early predictors of which infants will die or will have significant neurologic sequelae. It is hypothesized that neonatal seizures may be a better indicator of the severity or duration of intrauterine asphyxia than the Apgar score. In the neonate with seizures, the use of the formula may allow identification of infants at high risk for adverse outcomes.

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Umbilical Cord Blood Gas Analysis, Obstetric Performance and Perinatal Outcome

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1675187 ◽

2018 ◽

Vol 40 (12) ◽

pp. 740-748 ◽

Cited By ~ 1

Author(s):

Cátia Ferreira ◽

Ângela Melo ◽

Ana Fachada ◽

Helena Solheiro ◽

Nuno Nogueira Martins

Keyword(s):

Umbilical Cord Blood ◽

Apgar Score ◽

Umbilical Artery ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Neonatal Hypoxia ◽

Total Cohort ◽

Group A ◽

Minute Apgar Score

Objective To analyze if umbilical artery pH (pHua) ≤7.00 and umbilical artery blood deficit (BDua) ≥12.00 mmol/L are good predictors of adverse neonatal outcomes. Methods This was an observational, longitudinal and retrospective cohort study, conducted at the department of obstetrics and gynecology of Centro Hospitalar Tondela Viseu between September 2013 and September 2015. Total cohort and subgroup analysis were performed: group A—women with umbilical cord blood gas analysis (UCBGA) performed for non-reassuring fetal cardiotocographic patterns, placental abruption, or shoulder dystocia; and group B—all the others. Assays were made with the software SPSS for Windows, Versions 20.0 and 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 428 UCBGAs met the inclusion criteria. The group analysis revealed an association between group A and pHua ≤7.00, as well as between BDua ≥12.00 mmol/L and 1st minute Apgar score ≤4 (p = 0.011). After the application of the logistic regression models in the total cohort analysis, pHua ≤7.00 had an impact in the occurrence of acute neonatal hypoxia (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 1.21–37.06; p = 0.029); multiparous women had a higher risk of delivering a newborn with first minute Apgar score ≤4 and acute neonatal hypoxia (OR: 5.38; 95% CI: 1.35–21.43; p = 0.017; and OR: 2.66; 95% CI: 1.03–6.89, p = 0.043, respectively); women who had urologic problems during pregnancy had a higher risk of delivering a newborn with 5th minute Apgar score ≤7 (OR: 15.17; 95% CI: 1.29–177.99; p = 0.030); and shoulder dystocia represented a 15 times higher risk of acute neonatal hypoxia (OR: 14.82; 95% CI: 2.20–99.60; p = 0.006). Conclusion The pHua and the BDua are predictors of adverse neonatal outcome, and UCBGA is a useful tool for screening newborns at risk. Universal UCBGA should be considered for all deliveries, as it is an accurate screening test for neonatal hypoxia.

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Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2015-308483 ◽

2015 ◽

Vol 101 (2) ◽

pp. F121-F126 ◽

Cited By ~ 15

Author(s):

Emily J Tweed ◽

Daniel F Mackay ◽

Scott M Nelson ◽

Sally-Ann Cooper ◽

Jill P Pell

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Apgar Score ◽

Educational Outcomes ◽

Retrospective Cohort ◽

Minute Apgar Score

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Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy

American Journal of Perinatology ◽

10.1055/s-0040-1715822 ◽

2020 ◽

Author(s):

Abigail Flower ◽

Daniel Vasiliu ◽

Tianrui Zhu ◽

Robert Andris ◽

Maryam Abubakar ◽

...

Keyword(s):

Blood Pressure ◽

Frequency Domain ◽

Arterial Blood Pressure ◽

Apgar Score ◽

Blood Pressure Variability ◽

Hypoxic Ischemic Encephalopathy ◽

Arterial Blood ◽

The Mean ◽

Minute Apgar Score ◽

Ischemic Encephalopathy

Objective This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE). Study Design In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate–severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis. Results Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86. Conclusion Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE. Key Points

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The 5-minute Apgar Score as a Prognostic Factor for Development and Progression of Retinopathy of Prematurity

Folia Medica ◽

10.1515/folmed-2017-0011 ◽

2017 ◽

Vol 59 (1) ◽

pp. 78-83 ◽

Cited By ~ 4

Author(s):

Vasil G. Marinov ◽

Desislava N. Koleva-Georgieva ◽

Nelly P. Sivkova ◽

Maya B. Krasteva

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Retinopathy Of Prematurity ◽

Apgar Score ◽

Prognostic Significance ◽

Significant Risk ◽

Exact Test ◽

Group I ◽

Group Ii ◽

Minute Apgar Score

Abstract Background: A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP). Aim: To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP. Materials and methods: The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic significance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA - spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ2 or Fisher’s exact test were used in the statistical analysis. Logistic regression was performed to find significant and independent risk factors for manifestation and progression of ROP. Results: A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically significant risk factors of ROP (р=0.191, р=0.191, respectively), but were significant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively). Conclusion: An Apgar score at 5 minutes of 6 or less was a significant and independent risk factor for progression of ROP to stages requiring treatment.

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