Determinants of low APGAR score among preeclamptic deliveries in Cipto Mangunkusumo Hospital: a retrospective cohort study in 2014

Background: Preeclampsia has great implication on adverse neonatal outcome. Appearance, pulse, grimace, activity, respiration (APGAR) score at 1 or 5 minutes is one of the indicators of physiologic maturity of the infant. Therefore, the aim of this study was to know the correlation of APGAR score in preeclamptic deliveries with its risk factors. Methods: This study was a retrospective cohort. Data were collected from January to December 2013 including all preeclamptic women with singleton live pregnancies who delivered their babies in Cipto Mangunkusumo Hospital, Jakarta. The primary outcome was APGAR score. There were some determinants conducted in this study. Binary logistic was used as multivariate analysis to analyze the correlation between APGAR score and risk factors of preeclampsia, data were analyzed using chi square test. Results: Out of 450 preeclamptic women, 446 of them met the inclusion criteria. Low APGAR scores at 1 and 5 minutes were found in 19% (86/446) and 5.4% (24/446) of neonates respectively. Early onset of preeclampsia (adjusted OR = 4.577; 95% CI = 2.147 - 9.757), white blood cell ≥ 15,000/μL (adjusted OR = 3.315; 95% CI = 1.738 – 6.324), HELLP syndrome (adjusted OR = 2.00; 95% CI = 1.38 – 2.91) were independent risk factors for having infant with low APGAR score at 1 minute. Meanwhile, there was no significant risk factors at 5 minutes APGAR score after adjustment.Conclusion: Leukocytosis, early onset preeclampsia, preterm birth, and thrombocytopenia, severity of preeclampsia, and HELLP syndrome are independent risks of having infant born with low APGAR score at 1 minute in preeclamptic deliveries.

Effect of Soybean Cyst Nematode on Fatty Acid Levels of Soybean Seed

Growing soybean cyst nematode (SCN, Heterodera glycines Ichinohe) resistant varieties in fields infested with SCN can improve yield, but the impact of SCN on seed quality of lines with modified seed composition is unknown. The objective of this study was to determine if SCN resistant or susceptible rootstock influenced the composition of seed of soybean lines developed for desirable elevated levels of unsaturated fatty acids (FA). Five soybean lines with modified or normal levels of FA were Y-grafted to generate a 5-×-5 combination of plants with a SCN susceptible (SCNS) or resistant (SCNR) rootstock having a self-grafted branch, a scion (alien) grafted branch, or non-grafted branch; control plants were not grafted. In 2004 and 2005 plants were transplanted into blocks of Asgrow 3302 (SCNR) or Asgrow 3701 (SCNS) verified to be infested with SCN. Seeds were harvested at physiologic maturity (R8) in 2004 and 2005 and analyzed for five unsaturated FA. Differences in FA levels between 2004 and 2005 were significant (P < 0.05), but there were no significant (P = 0.05) block × year effects. Significant differences were observed between the FA levels of seed harvested from non-grafted control plants and self-grafted or non-grafted branches of grafted plants within lines. Seed oleic acid of the mid-oleic line S03-1379-2 was significantly greater when grafted onto an SCNR line than when grafted onto SCNS lines. The low linolenate trait appeared to be insensitive to SCN presence as seed linolenic acid of the low linolenic line IA-3017 was not different when grafted onto SCNR or SCNS lines. SCN can negatively impact the expression of seed quality of soybean if grown where SCN infestations are evident. Accepted for publication 8 September 2008. Published 3 November 2008.

INFLUENCE OF POPULATION ON WHITE LUPIN MORPHOLOGY AND YIELD

The influence of plant population on sweet white lupin (Lupinus albus L. ’Ultra’) growth and production were investigated during 1985 and 1987. In 1985, white lupin was sown at populations of 11, 20, 44 and 178 plants m−2, and in 1987 populations of 20, 44, and 100 plants m−2. Plant density had a significant influence on seed and total plant yields and yield components. Seed yields ranged between 2182 and 3708 kg ha−1, and total plant forage yields (at maximum LAI) ranged between 2044 and 11 501 kg ha−1 at populations of 11 to 178 plants m−2. Main-stem and lateral pods, seed pod−1, potential fruiting sites and lateral branch number were inversely proportional to plant density. Lateral pod production was more sensitive to population pressure than main-stem pod production. The number of lateral pods plant−1 was a linear function, whereas the number of main-stem pods plant−1 was a curvilinear function of the inverse of plant population.Key words: Lupinus albus, L. ’Ultra’, physiologic maturity, flower and fruit potential, lupin

Use and Abuse of the Apgar Score

The Apgar score, devised in 1952 by Dr Virginia Apgar, is a quick method of assessing the state of the newborn infant.1,2 The ease of scoring has led to its use in many studies of outcome. However, its misuse, as in current International Classification of Diseases, revision 9, coding, has led to an erroneous definition of asphyxia.* Although the Apgar score continues to provide a convenient shorthand for reporting the state of the baby and the effectiveness of resuscitation, the purpose of this statement is to place the Apgar score in its proper perspective as a tool for assessing asphyxia and for prognostication of future neurologic deficit. The Apgar score is comprised of five components: heart rate, respiratory effort, tone, reflex irritability, and color, each of which can be given a score of 0, 1, or 2 (Table). FACTORS THAT MAY AFFECT THE APGAR SCORE Although rarely stated, it is important to recognize that elements of the score such as tone, color, and reflex irritability are partially dependent on the physiologic maturity of the infant. The normal premature infant may thus receive a low score purely because of immaturity with no evidence of anoxic insult or cerebral depression. Maternal sedation or analgesia may decrease tone and responsiveness. Neurologic conditions such as muscle disease or cerebral malformations may decrease tone and interfere with respiration. Cardiorespiratory conditions may interfere with heart rate, respiration, and tone. Thus, to equate the presence of a low Apgar score solely with asphyxia represents a misuse of the score.

Urinary organic acids quantitated by age groups in a healthy pediatric population.

Urine samples from 92 individuals of a healthy pediatric population ranging in age from less than 24 h to 12 years were analyzed for organic acid content (amino acids excepted). A few samples from adults were included for purposes of comparison. Acids were extracted by using an anion-exchange procedure, converted to trimethylsilyloxime derivatives, and analyzed by gas chromatography with the help of a small computer system. Identifications were confirmed by using a combined gas chromatograph/mass spectrometer/computer system. The data has been tabulated according to five pediatric age groups. Despite large individual variation within age groups, significant differences in amounts of several acids excreted (based on urinary creatinine concentration) have been determined between age groups. Such differences might be due to one or a combination of several factors, including changes with age in creatinine excretion, in physiologic maturity, and in diet. Such data may help to provide a basis for diagnosing metabolic abnormalities in pediatric patients.

Special Susceptibility of the Fetal and Neonatal Hematopoietic System to Chemical Pollutants Including Drugs Administered to the Mother

Because of the anemia or bleeding that may herald the adverse impact of any agent upon the hematopoietic system, the capacity of drugs, insecticides, lead, and other agents to cause malfunction of this system has long been recognized. As a matter of fact, the major therapeutic step in the management of recognized aplastic anemia is to separate the child from his environment even before the offending agent has been identified. There is, however, no good evidence to date that the child or neonate is singularly susceptible to aplastic anemia or neutropenia from such agents. In response to other agents, there is a special susceptibility of the hematopoietic system in the fetus and newborn. One special feature of the fetus affecting susceptibility to environmental agents is that, in a sense, he is trapped in his environment; and, we cannot extract him early enough from exposures via the mother and placenta. The smoking mother, the heroin addict, and the mother exposed to industrial pollutants are the conduits through whom poisons may reach the fetus. The special features of fetal physiology, the stage of organ development, and the phase of physiologic maturity dictate the uniqueness of response at a particular time in gestation or immediately after delivery. CHEMICAL EFFECTS ON RED CELLS OR PLATELETS In the last trimester women take an average of 8.7 drug agents or vitamins and 80% of these agents are taken without medical supervision. The impact of these agents on red cells, white cells, platelets, the fetal coagulation system, and on the appearance of pigments formed during red cell destruction are in some instances predictable because of the growing fund of information concerning the unique physiology of these cells and systems in the fetus and newborn.