1
|
Lake ES, Abita Z, Erega BB. Determinants of birth asphyxia among newborns in south Gondar Zone public hospitals, North West Ethiopia, 2021: A case control study. Heliyon 2024; 10:e30093. [PMID: 38707282 PMCID: PMC11068594 DOI: 10.1016/j.heliyon.2024.e30093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Birth asphyxia is one of the leading causes of neonatal mortality, which accounts for around 24 % of overall neonatal mortality. Neonatal death usually results from preventable factors. Thus, this study has aimed to identify the determinant factors of birth asphyxia among newborns in South Gondar Zone public hospitals. Methods Institution based unmatched case control study and systematic random sampling technique was conducted in South Gondar zone public hospitals from March October 2021 to May 20/2021. A pretested interviewer administered questionnaire and a data retrieving checklist was used for data collection. Cases were selected if one of the following was present at birth: (gasping, no breathing, or breathing rate of below 30 per minute). Epidata version 4.6 software was used for data entry and bivariate logistic regression and multivariable logistic regression techniques were used for data analysis using SPSS version 23. Result In this study, Instrumental delivery (AOR = 3.19, 95%CI: 1.23-8.36), labor abnormality (AOR = 3.24, 95%CI: 1.31-8.03), cord prolapse (AOR = 7.06, 95%CI:2.25-22.50),APH (AOR = 4.68,95%CI:2.00-10.95) and preterm birth (AOR = 3.84,95%CI:1.32-11.20) were predictors of birth asphyxia. Conclusion Labor abnormality, ante-partum hemorrhage, cord prolapse, instrumental delivery and preterm birth were independent predictors of birth asphyxia.
Collapse
Affiliation(s)
- Eyob Shitie Lake
- Department of Midwifery, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Zinie Abita
- School of Public Health, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Besfat Berihun Erega
- Department of Clinical Midwifery, Collage of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
2
|
Hong J, Crawford K, Jarrett K, Triggs T, Kumar S. Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants - an Australian population-based cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:101011. [PMID: 38292653 PMCID: PMC10825608 DOI: 10.1016/j.lanwpc.2024.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
Background The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0-38+6 weeks), full term (39+0-40+6 weeks), late term (41+0-41+6 weeks), and post term (≥42+0 weeks) infants. Methods This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4-6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Findings Of the study cohort, 0.04% (345/941,221) were neonatal deaths, 0.70% (6627/941,221) were infants with severe neurological morbidity and 4.3% (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95% CI 560.96, 1318.94, p < 0.001); full term (aRRR 1835.77, 95% CI 1279.48, 2633.91, p < 0.001); late term (aRRR 1693.61, 95% CI 859.65, 3336.6, p < 0.001) and post term (aRRR 2231.59, 95% CI 272.23, 18293.07, p < 0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95% CI 118.74, 211.51, p < 0.001); full term (aRRR 112.99, 95% CI 90.56, 140.98, p < 0.001); late term (aRRR 87.94, 95% CI 67.09, 115.27, p < 0.001) and post term (aRRR 52.07, 95% CI 15.17, 178.70, p < 0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2-3 cohort (aRRR 7.36, 95% CI 6.2, 8.74, p < 0.001). Interpretation A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks' gestation with the risk greatest in the early term cohort. Funding National Health and Medical Research Council and Mater Foundation.
Collapse
Affiliation(s)
- Jesrine Hong
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kylie Crawford
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Kate Jarrett
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
| | - Tegan Triggs
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
- NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
3
|
Junior LCM, Pinto CN, Gerencer CS, Pro ECG, de Carvalho HB. Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case-control study. Arch Gynecol Obstet 2023; 308:1473-1483. [PMID: 36374349 PMCID: PMC9662118 DOI: 10.1007/s00404-022-06832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. METHODS A retrospective case-control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. RESULTS Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. CONCLUSION Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar.
Collapse
Affiliation(s)
- Luís Carlos Machado Junior
- Universidade de São Paulo/Faculdade de Medicina/Centro de Saúde Escola Samuel Barnsley Pessoa, São Paulo, Brazil.
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil.
| | - Camila Nazareth Pinto
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Caroline Sangalan Gerencer
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | - Elisa Caroline Giacometti Pro
- Hospital Municipal Universitário de São Bernardo do Campo, R. Alexandre Benois, 180, ap. 101, São Paulo, SP, CEP 05270 090, Brazil
| | | |
Collapse
|
4
|
Knobbe H, Damer EA, Edens MA, Nij Bijvank BSWA, Hemels MAC, Ter Horst PGJ. Maternal and neonatal outcomes after benzodiazepine and benzodiazepine agonist exposure during pregnancy in women with mental disorders. Br J Clin Pharmacol 2023; 89:3005-3015. [PMID: 37218067 DOI: 10.1111/bcp.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS To compare the gestational age of neonates in utero exposed to benzodiazepines (BDZs) with nonexposed controls. Secondary objectives were birth weight, presence of congenital malformations, APGAR score and the need for >3 months (prolonged) maternal psychiatric care. METHODS A retrospective cohort study of women and neonates from 2013 to 2021 with univariate and multivariable analysis to study the associations between BDZ exposure and gestational age compared to nonexposed women with mental health problems. RESULTS We found that BDZ exposure was not associated with a lower gestational age. We found that women in the exposed group had an increased risk of psychiatric care (adjusted odds ratio 2.58 [95% confidence interval 1.71-3.91], P < .001). CONCLUSION We found that in utero BDZ exposure was not associated with a significantly lower gestational age of the neonates and was associated with prolonged psychiatric care of their mothers.
Collapse
Affiliation(s)
- Hennique Knobbe
- Department of Clinical Pharmacy, Isala, Zwolle, The Netherlands
| | - Elvera A Damer
- Department of Psychiatry, Isala, Zwolle, The Netherlands
| | | | | | | | | |
Collapse
|
5
|
Gajewska E, Moczko J, Naczk M, Naczk A, Sobieska M. Impact of selected risk factors on motor performance in the third month of life and motor development in the ninth month. PeerJ 2023; 11:e15460. [PMID: 37334124 PMCID: PMC10274587 DOI: 10.7717/peerj.15460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
Background Proper motor development can be influenced by a range of risk factors. The resulting motor performance can be assessed through quantitative and qualitative analysis of posture and movement patterns. Methods This study was designed as the cohort follow-up of the motor assessment and aimed to demonstrate, in a mathematical way, the impact of particular risk factors on elements of motor performance in the 3rd month and the final motor performance in the 9th month of life. Four hundred nineteen children were assessed (236 male and 183 female), including 129 born preterm. Each child aged 3 month underwent a physiotherapeutic assessment of the quantitative and qualitative development, in the prone and supine positions. The neurologist examined each child aged 9 month, referring to the Denver Development Screening Test II and assessing reflexes, muscle tone and symmetry. The following risk factors were analyzed after the neurological consultation: condition at birth (5th min Apgar score), week of gestation at birth, intraventricular hemorrhage, respiratory distress syndrome, and the incidence of intrauterine hypotrophy and hyperbilirubinemia determined based on medical records. Results A combination of several risk factors affected motor development stronger than any one of them solely, with Apgar score, hyperbilirubinemia, and intraventricular hemorrhage exhibiting the most significant impact. Conclusions Premature birth on its own did not cause a substantial delay in motor development. Nonetheless, its co-occurrence with other risk factors, namely intraventricular hemorrhage, respiratory distress syndrome, and hyperbilirubinemia, notably worsened motor development prognosis. Moreover, improper position of the vertebral column, scapulae, shoulders, and pelvis in the third month of life may predict disturbances in further motor development.
Collapse
Affiliation(s)
- Ewa Gajewska
- Chair and Clinic of the Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariusz Naczk
- Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - Alicja Naczk
- Department of Physical Education and Sport, Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, Gorzow Wielkopolski, Poland
| | - Magdalena Sobieska
- Department of Rehabilitation and Physiotherapy, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
6
|
Lin XS, Peng XY, Yang MM, Ning LL, Shao YW, Jiang Y, Feng SW, Luo Q. The single pregnancy predicting model of 1 minute Apgar score less than 7 after preterm birth: A retrospective study. PLoS One 2022; 17:e0279385. [PMID: 36548293 PMCID: PMC9778627 DOI: 10.1371/journal.pone.0279385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Preterm delivery is greatly associated with perinatal mortality and morbidity, while there is no objective way to identify high-risk newborns currently. This study aimed at discovering the risk factor for Apgar score less than 7 at 1 minute of preterm neonates born with vaginal delivery. A retrospective study was performed in single pregnancy women with a vaginal delivery before 37 weeks of gestation. All the preterm infants were categorized into three types: very preterm birth (28 to 32 weeks), moderate preterm birth (32 to 34 weeks) and late preterm birth (34 to 37 weeks). Risk factors were identified through logistic regression analysis in every category of newborns mentioned above. And the receiver operating characteristic analysis was used in continuous variables to determine the best threshold of the outcome. On the basis of the selected factors, the predicting models are created and its prognosticating ability is compared by the area under the curve. A nomogram was established for the proved best model. A total of 981 cases were investigated, of whom 55 were found with 1 min Apgar scores less than 7. The nomogram was set for the predicting model with larger area under the receiver operating characteristic curve, of which is 0.742(95% confidence interval = 0.670-0.805) in very preterm birth, with the variables of first and second labor stage(> = 1.6 hours), birthweight and MgSO4(magnesium sulfate), and is 0.807(95% confidence interval = 0.776-0.837) in late preterm birth, with the variables of second labor stage(> = 1.23 hours), birthweight, a history of previous cesarean delivery, fetal distress and placental abruption. The combination of first and second labor stage, newborn weight and MgSO4 use can predict 74.2% of 1 minute Apgar score < 7 in very preterm neonates. And 80.7% high-risk infants can be identified when second labor stage, newborn weight, VBAC (vaginal birth after cesarean) and the occur of placental abruption and fetal distress were combined in the predicting model for late preterm birth. These predicting models would bring out great assistance towards obstetricians and reduce unnecessary adverse fetal outcomes.
Collapse
Affiliation(s)
- Xi-Shi Lin
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Xin-Yun Peng
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Meng-Meng Yang
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Lin-li Ning
- Hangzhou Fuyang Women and Children Hospital, Hangzhou, China
| | - Yu-Wei Shao
- Changxing Women and Children’s Hospital, Huzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Su-Wen Feng
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
- * E-mail: (QL); (SWF)
| | - Qiong Luo
- Department of Obstetrics, Women’s Hospital, Zhejiang University, School of Medicine, Hangzhou, China
- * E-mail: (QL); (SWF)
| |
Collapse
|
7
|
Nikbina M, Sayahi M. Harlequin ichthyosis newborn: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221139610. [PMCID: PMC9742929 DOI: 10.1177/2050313x221139610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
Harlequin ichthyosis is a rare and severe genetic skin disorder that occurs
within the developing foetus. Harlequin ichthyosis is the most severe and
devastating form of autosomal recessive congenital ichthyoses. It is caused by
mutations in the lipid transporter adenosine triphosphate binding cassette A 12.
Here, we reported a case of harlequin ichthyosis with no family history. No
abnormalities were detected in prenatal sonography. A 24-year-old pregnant woman
with premature rupture of membrane and labour pain was referred to a hospital in
Shoushtar city, Iran. The mother delivered a male baby with harlequin
ichthyosis. The infant baby died on the 5th day. Harlequin ichthyosis is
associated with adenosine triphosphate binding cassette A 12 gene mutation;
therefore, genetic screening and counselling for susceptible parents should be
taken into account. Prenatal diagnosis of harlequin ichthyosis principally via
sonographic techniques is important in managing the disorder.
Collapse
Affiliation(s)
- Maryam Nikbina
- Maryam Nikbina, Department of Midwifery,
Shoushtar Faculty of Medical Sciences, Shahid Sherafat Blvd, Shoushtar,
84534-64516, Iran.
| | | |
Collapse
|
8
|
Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study. BMC Pregnancy Childbirth 2022; 22:665. [PMID: 36028804 PMCID: PMC9413889 DOI: 10.1186/s12884-022-04999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Apgar score is used to evaluate the neonates' overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section. METHODS An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score > = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05. RESULT Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019. CONCLUSIONS Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..
Collapse
|
9
|
Girling J, Knight CL, Chappell L. Intrahepatic cholestasis of pregnancy: Green-top Guideline No. 43 June 2022: Green-top Guideline No. 43 June 2022. BJOG 2022; 129:e95-e114. [PMID: 35942656 DOI: 10.1111/1471-0528.17206] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Distributed Big Data Analytics Method for the Early Prediction of the Neonatal 5-Minute Apgar Score before or during Birth and Ranking the Risk Factors from a National Dataset. AI 2022. [DOI: 10.3390/ai3020023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One-minute and five-minute Apgar scores are good measures to assess the health status of newborns. A five-minute Apgar score can predict the risk of some disorders such as asphyxia, encephalopathy, cerebral palsy and ADHD. The early prediction of Apgar score before or during birth and ranking the risk factors can be helpful to manage and reduce the probability of birth producing low Apgar scores. Therefore, the main aim of this study is the early prediction of the neonate 5-min Apgar score before or during birth and ranking the risk factors for a big national dataset using big data analytics methods. In this study, a big dataset including 60 features describing birth cases registered in Iranian maternal and neonatal (IMAN) registry from 1 April 2016 to 1 January 2017 is collected. A distributed big data analytics method for the early prediction of neonate Apgar score and a distributed big data feature ranking method for ranking the predictors of neonate Apgar score are proposed in this study. The main aim of this study is to provide the ability to predict birth cases with low Apgar scores by analyzing the features that describe prenatal properties before or during birth. The top 14 features were identified in this study and used for training the classifiers. Our proposed stack ensemble outperforms the compared classifiers with an accuracy of 99.37 ± 1.06, precision of 99.37 ± 1.06, recall of 99.50 ± 0.61 and F-score of 99.41 ± 0.70 (for confidence interval of 95%) to predict low, moderate and high 5-min Apgar scores. Among the top predictors, fetal height around the baby’s head and fetal weight denote fetal growth status. Fetal growth restrictions can lead to low or moderate 5-min Apgar score. Moreover, hospital type and medical science university are healthcare system-related factors that can be managed via improving the quality of healthcare services all over the country.
Collapse
|
11
|
He H, Yu Y, Wang H, Obel CL, Li F, Li J. Five-Minute Apgar Score and the Risk of Mental Disorders During the First Four Decades of Life: A Nationwide Registry-Based Cohort Study in Denmark. Front Med (Lausanne) 2022; 8:796544. [PMID: 35096886 PMCID: PMC8795588 DOI: 10.3389/fmed.2021.796544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: The associations of long-term risks of the full spectrum of mental disorders with clinically reassuring but suboptimal score range 7–9 remain unclear. This study investigated these associations during up to 38 years of follow-up. Methods: In a nationwide cohort study of 2,213,822 singletons born in Denmark during 1978–2015, we used cox regression to estimate the hazard ratio (HR) of mental disorders with a 95% CI. Results: A total of 3,00,679 (13.6%) individuals were diagnosed with mental disorders. The associations between suboptimal Apgar score 7–9 and mental disorders differed by attained age. In childhood (≤ 18 years), declining Apgar scores were associated with increased risks of overall mental disorders with HRs (95% CI) of 1.13(1.11-1.15), 1.34 (1.27–1.41), and 1.48 (1.31–1.67) for Apgar scores of 7–9, 4–6, and 1–3, respectively, compared with a score of 10. A dose-response association was seen even within the score range from 9 to 7 (HR 1.11 [95% CI: 1.08–1.13], 1.14 [1.10–1.18], and 1.20 [1.14–1.27], respectively). Of note, individuals with scores of 7–9 had increased risks of organic disorders (HR: 1.27, 95% CI: 1.05–1.53), neurotic disorders (HR: 1.07, 95% CI: 1.03–1.11), and a wide range of neurodevelopmental disorders, such as intellectual disability (1.87, 1.76–1.98), childhood autism (1.13, 1.05–1.22) and attention deficit hyperactivity disorder (1.10, 1.06–1.15). In early adulthood (19–39 years), suboptimal Apgar scores 7–9 were not associated with the risks of overall and specific mental disorders. Conclusion: Infants born with clinically reassuring but suboptimal 5-min scores 7–9 are at increased risks of a wide spectrum of mental disorders in childhood.
Collapse
Affiliation(s)
- Hua He
- Developmental and Behavioral Pediatric Department and Child Primary Care Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hui Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fei Li
- Developmental and Behavioral Pediatric Department and Child Primary Care Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiong Li
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| |
Collapse
|
12
|
Damer EA, Edens MA, van der Loos MLM, van Esenkbrink J, Bunkers I, van Roon EN, Ter Horst PGJ. Fifteen years' experience with methylphenidate for attention-deficit disorder during pregnancy: Effects on birth weight, Apgar score and congenital malformation rates. Gen Hosp Psychiatry 2021; 73:9-15. [PMID: 34507078 DOI: 10.1016/j.genhosppsych.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methylphenidate (MPD) is increasingly prescribed to fertile women with Attention-Deficit Disorder (AD(H)D), with or without hyperactivity, despite advice for discontinuation during pregnancy. Few studies report on results concerning safety after methylphenidate exposure during pregnancy for the offspring. AIM Safety for the offspring of exposure to MPD during pregnancy. METHODS This is an observational retrospective cohort study in a population of pregnant women and their offspring, treated with MPD for ADHD in the Psychiatry-Gynaecology-Pediatrics outpatient clinic between 1 January 2005 and 1 June 2020 at Isala hospital. The primary endpoints were birth weight and Apgar score in offspring exposed to MPD during pregnancy, compared to offspring unexposed to MPD. Birth weight was analysed using linear mixed model analysis. Apgar score and (secondary endpoint) neonatal malformations, at 20 week ultrasound, were analysed using basic univariate statistical analysis. RESULTS MPD continuation, compared to discontinuation, was associated with higher neonatal birth weight (p = 0.049), but lost statistical significance after incorporating covariates (p = 0.079). There were no significant differences in Apgar scores and congenital malformations between neonates exposed and unexposed to MPD. CONCLUSIONS MPD does not seem to affect birth weight, Apgar score and the frequency of neonatal malformations at the 20 week ultrasound.
Collapse
Affiliation(s)
- E A Damer
- Isala, Department of Psychiatry, P.o.box 10400, 8000, GK, Zwolle, the Netherlands.
| | - M A Edens
- Isala, Department of Science and Innovation, P.o.box 10400, 8000, GK, Zwolle, the Netherlands.
| | - M L M van der Loos
- Isala, Department of Psychiatry, P.o.box 10400, 8000, GK, Zwolle, the Netherlands.
| | - J van Esenkbrink
- Isala, Department of Psychiatry, P.o.box 10400, 8000, GK, Zwolle, the Netherlands
| | - I Bunkers
- Isala, Department of Psychiatry, P.o.box 10400, 8000, GK, Zwolle, the Netherlands
| | - E N van Roon
- Medical Center Leeuwarden, Department of Hospital Pharmacy and Pharmacology, P.o. box 888, 8901, BR, Leeuwarden, the Netherlands.
| | - P G J Ter Horst
- Isala, Department of Hospital Pharmacy and Pharmacology, P.o.box 10400, 8000, GK, Zwolle, the Netherlands.
| |
Collapse
|
13
|
Tarimo CS, Bhuyan SS, Li Q, Ren W, Mahande MJ, Wu J. Combining Resampling Strategies and Ensemble Machine Learning Methods to Enhance Prediction of Neonates with a Low Apgar Score After Induction of Labor in Northern Tanzania. Risk Manag Healthc Policy 2021; 14:3711-3720. [PMID: 34522147 PMCID: PMC8434924 DOI: 10.2147/rmhp.s331077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The goal of this study was to establish the most efficient boosting method in predicting neonatal low Apgar scores following labor induction intervention and to assess whether resampling strategies would improve the predictive performance of the selected boosting algorithms. Methods A total of 7716 singleton births delivered from 2000 to 2015 were analyzed. Cesarean deliveries following labor induction, deliveries with abnormal presentation, and deliveries with missing Apgar score or delivery mode information were excluded. We examined the effect of resampling approaches or data preprocessing on predicting low Apgar scores, specifically the synthetic minority oversampling technique (SMOTE), borderline-SMOTE, and the random undersampling (RUS) technique. Sensitivity, specificity, precision, area under receiver operating curve (AUROC), F-score, positive predicted values (PPV), negative predicted values (NPV) and accuracy of the three (3) boosting-based ensemble methods were used to evaluate their discriminative ability. The ensemble learning models tested include adoptive boosting (AdaBoost), gradient boosting (GB) and extreme gradient boosting method (XGBoost). Results The prevalence of low (<7) Apgar scores was 9.5% (n = 733). The prediction models performed nearly similar in their baseline mode. Following the application of resampling techniques, borderline-SMOTE significantly improved the predictive performance of all the boosting-based ensemble methods under observation in terms of sensitivity, F1-score, AUROC and PPV. Conclusion Policymakers, healthcare informaticians and neonatologists should consider implementing data preprocessing strategies when predicting a neonatal outcome with imbalanced data to enhance efficiency. The process may be more effective when borderline-SMOTE technique is deployed on the selected ensemble classifiers. However, future research may focus on testing additional resampling techniques, performing feature engineering, variable selection and optimizing further the ensemble learning hyperparameters.
Collapse
Affiliation(s)
- Clifford Silver Tarimo
- Department of Epidemiology and Health Statistics, Zhengzhou University, Zhengzhou, People's Republic of China.,Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Quanman Li
- Department of Epidemiology and Health Statistics, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Weicun Ren
- College of Sanquan, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Michael Johnson Mahande
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jian Wu
- Department of Epidemiology and Health Statistics, Zhengzhou University, Zhengzhou, People's Republic of China
| |
Collapse
|
14
|
Yeshaneh A, Kassa A, Kassa ZY, Adane D, Fikadu Y, Wassie ST, Alemu BW, Tadese M, Shitu S, Abebe H. The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia. BMC Pediatr 2021; 21:266. [PMID: 34103025 PMCID: PMC8186153 DOI: 10.1186/s12887-021-02745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/31/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Newborn morbidity and mortality are forecasted using the Apgar scores. Obstetricians worldwide have used the Apgar score for more than half a century for the assessment of immediate newborn conditions. It is a simple and convenient evaluation system that offers a standardized and effective assessment of newborn infants. Neonatal morbidity and mortality can be reduced if high-risk neonates are identified and managed adequately. This study aimed to assess the determinants of 5th minute low Apgar score among newborns at Public hospitals in Hawassa city, South Ethiopia. METHODS A hospital-based unmatched case-control study was conducted at Public Hospitals in Hawassa city. Data were collected from 134 cases and 267 controls using a structured and pre-tested questionnaire by observing, interviewing, and reviewing patient cards. Newborns who delivered with a 5th minute Apgar score < 7 were considered as cases; whereas a similar group of newborns with a 5th minute Apgar score of ≥ 7 were categorized as controls. A consecutive sampling technique was employed to recruit cases, while a simple random sampling technique was used to select controls. Data entry and analysis were performed using Epi Data version 3.1 and SPSS version 20 respectively. Binary and multivariable analyses with a 95 % confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. RESULTS After controlling for possible confounding factors, the results showed that lack of physical and emotional support during labor and delivery [AOR = 3.5, 95 %CI:1.82-6.76], rural residence [AOR = 4, 95 %CI: 2.21-7.34], lack of antenatal care follow up [AOR = 3.5, 95 % CI: 1.91-6.33], anemia during pregnancy [AOR = 2.3,95 %CI: 1.10-4.71] and low birth weight [AOR = 6.2, 95 %CI: 2.78-14.03] were determinant factors of low Apgar scores. The area under the Apgar score ROC curve was 87.4 %. CONCLUSIONS Lack of physical and emotional support, rural residence, lack of ANC follow-up, low birth weight, and anemia during pregnancy were determinant factors of a low Apgar score. `Effective health education during preconception about anemia during pregnancy and ANC will help in detecting high-risk pregnancies that lead to a low Apgar score. In addition to the standard care of using electronic fetal monitoring, increasing access to compassion ships during labor and delivery is recommended.
Collapse
Affiliation(s)
- Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia.
| | - Andargachew Kassa
- Department of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zemenu Yohannes Kassa
- Department of midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Daniel Adane
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Semahegn Tilahun Wassie
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Tepi, Ethiopia
| | - Biresaw Wassihun Alemu
- Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Mesfin Tadese
- Department of Midwifery, College of Medicine and Health Sciences, Debrebirhan University, Debrebirhan, Ethiopia
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Haimanot Abebe
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| |
Collapse
|
15
|
Zhou Y, Li L, Wang L, Zhang C. Prenatal diagnosis of a rare variant of harlequin ichthyosis with literature review. BMC Med Imaging 2021; 21:56. [PMID: 33743627 PMCID: PMC7981911 DOI: 10.1186/s12880-021-00586-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Harlequin ichthyosis (HI) is a rare and severe genetic skin disorder that occurs within the developing foetus. Due to the extremely poor prognosis, prenatal diagnosis becomes very important, especially for foetuses with no family history. There are few reports on prenatal diagnosis in PubMed. Case presentation We report two cases of HI with no family history who were diagnosed by prenatal ultrasound. We searched for reports on the prenatal ultrasonic diagnosis of HI over nearly two decades and summarized the sonographic features of HI, the reasons for missed diagnoses and matters needing attention. A total of 10 articles of congenital harlequin ichthyosis diagnosed by prenatal ultrasound in PubMed were retrieved. There have been even fewer reports of late-trimester disease with no family history. Combining the two cases we reported with the literature review, we summarize the ultrasonic image characteristics of HI. Conclusion HI can be easily detected by 2D ultrasound combined with 3D, but attention should be paid to a systematic examination in the third trimester of pregnancy according to the clinical characteristics of the disease.
Collapse
Affiliation(s)
- Yi Zhou
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Liang Li
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Ling Wang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, Anhui, China.
| |
Collapse
|
16
|
Tong H, Hao Q, Wang Z, Wang Y, Li R, Zhao X, Sun Q, Zhang X, Chen X, Zhu H, Huang D, Liu H. The biometric parameters of aniso-astigmatism and its risk factor in Chinese preschool children: the Nanjing eye study. BMC Ophthalmol 2021; 21:67. [PMID: 33535994 PMCID: PMC7860027 DOI: 10.1186/s12886-021-01808-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022] Open
Abstract
Backgrounds Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children. Methods In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model. Results Of 1131 children (66.90 ± 3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI) = 1.14–2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR) = 6.42, 95%CI = 2.63–15.69, P < 0.001; non-vectorial aniso-TA: OR = 4.99, 95%CI = 1.41–17.68, P = 0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR = 2.43, 95%CI = 1.05–5.60, P = 0.04). Pre-term delivery (OR = 2.60, 95%CI = 1.09–6.15, P = 0.03) and post-term delivery (OR = 3.61, 95%CI = 1.31–9.96, P = 0.01) were significantly associated with higher risk of vectorial aniso-CA. Conclusions Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score < 7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01808-7.
Collapse
Affiliation(s)
- Haohai Tong
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qingfeng Hao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zijin Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiaoyan Zhao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qigang Sun
- Department of Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, China
| | - Xiaohan Zhang
- Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Dan Huang
- Department of Child Healthcare, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
17
|
Proportion and predictive factors of low apgar score at five minute among singleton term neonates delivered in Debre Tabor specialized hospital, northwest Ethiopia: A cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
18
|
Orlovsky M, Meyer J, Mitelpunkt A, Weiss-Meilik A. Patient monitoring as a predictor of blood culture results in a tertiary neonatal intensive care unit. APPLIED ERGONOMICS 2021; 90:103233. [PMID: 32858394 DOI: 10.1016/j.apergo.2020.103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
We present a mesoergonomic approach to the early detection of neonatal sepsis, analyzing clinical data for 4999 patients from a neo-natal intensive care unit to predict positive culture results. The Apgar score at birth predicted positive results. For neonates with poor and intermediate Apgar scores, culture results for monitored infants were more likely to be positive than those for unmonitored infants. Thus, the medical staff tended to monitor infants who eventually had a greater chance for positive test results. A cost-effectiveness analysis indicated that for infants with high Apgar scores, the physician should decide whether to obtain a blood culture, based on the patient's characteristics. For infants with lower Apgar scores, it may be advisable to obtain a blood culture whenever one decides to monitor a neonate. The study demonstrates that staff decisions regarding a patient can serve as input for further clinical decision-making.
Collapse
Affiliation(s)
- Mila Orlovsky
- Clinical Operation Research and Quality Unit, Tel Aviv Medical Center, Israel; Department of Industrial Engineering, Tel Aviv University, Israel
| | - Joachim Meyer
- Department of Industrial Engineering, Tel Aviv University, Israel.
| | - Alexis Mitelpunkt
- Pediatric Neurology Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ahuva Weiss-Meilik
- Clinical Operation Research and Quality Unit, Tel Aviv Medical Center, Israel
| |
Collapse
|
19
|
Sun YF, Chang Q, Wu QJ, Gao SY, Zang ST, Liu YS, Zhao YH. Association between maternal antenatal depression and neonatal Apgar score: A systematic review and meta-analysis of prospective cohort studies. J Affect Disord 2021; 278:264-275. [PMID: 32977264 DOI: 10.1016/j.jad.2020.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Antenatal depression is common, but most women with the condition choose to remain untreated. The Apgar score, an important indicator of newborn health, has been reported to be influenced by antenatal depression; thus, maternal antenatal depression, as reflected by a poor Apgar score, may harm children's health. AIM To conduct a systematic review and meta-analysis to explore whether maternal antenatal depression is associated with the neonatal Apgar score. METHODS We registered the protocol for this study with PROSPERO (CRD42019137585). We searched PubMed, Embase, Web of Science, and the Cochrane Library for published papers that reported the association between depression and Apgar score from inception to December 4, 2019. Two reviewers independently screened and selected the studies according to the inclusion and exclusion criteria, and extracted data according to the predesigned table. Stata version 12.0 software was used to analyze data. RESULTS We finally identified 13 studies for inclusion, including a total of 12017 women. We did not find an association between antenatal depression and the 1 min Apgar score of neonates (mean difference= -0.03, 95% CI= -0.15-0.09) or the risk of a low Apgar score (OR=1.82, 95% CI=0.51 to 3.13). We found that antenatal depression increased the risk of a low Apgar score at 5 min (OR= 1.91, 95% CI= 1.23-2.59), but the association between the 5 min Apgar score and antenatal depression was not significant (mean difference= -0.001, 95% CI= -0.07-0.07). The results of the subgroup analyses also indicated that there was no association between the 5 min Apgar score and antenatal depression. CONCLUSIONS Antenatal depression increased the risk of a low 5 min Apgar score; however, we did not find a difference in the mean and distribution of neonatal Apgar scores of mothers with depression and mothers without depression.
Collapse
Affiliation(s)
- Yi-Fei Sun
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shan-Yan Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Si-Tian Zang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ya-Shu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning, MA 110004, China; Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
20
|
Tarvonen M, Hovi P, Sainio S, Vuorela P, Andersson S, Teramo K. Factors associated with intrapartum ZigZag pattern of fetal heart rate: A retrospective one-year cohort study of 5150 singleton childbirths. Eur J Obstet Gynecol Reprod Biol 2020; 258:118-125. [PMID: 33421808 DOI: 10.1016/j.ejogrb.2020.12.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/11/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Recent studies suggest that intrapartum ZigZag pattern of fetal heart rate (FHR) is significantly associated with cord blood acidaemia and neonatal complications. For the clinical significance of this pattern, it is mandatory that ZigZag episodes in cardiotocographic (CTG) recording are correctly identified. The aim of the present study was to examine maternal, fetal and delivery-related factors that could explain the occurrence of ZigZag pattern of FHR during the last 2 h of labour in a large obstetric cohort. STUDY DESIGN CTG recordings from 5150 singleton childbirths at ≥33 weeks of gestation during one year were evaluated retrospectively and blinded to pregnancy and neonatal outcomes in a university hospital in Helsinki, Finland. All women in the cohort were in the active phase of labour with regular uterine contractions. ZigZag FHR pattern was defined as FHR baseline amplitude changes of >25 bpm with a duration of 2-30 min. The following maternal, fetal and labour/delivery-related variables were determined: maternal age, obesity (prepregnancy BMI ≥ 30.0 kg/m2), parity, preeclampsia, maternal fever ≥38.0 °C, smoking, gestational age at delivery, fetal sex, birth weight z-score, mode of delivery, and type of onset of labour. RESULTS ZigZag pattern occurred in 582/5150 (11.3 %) cases, and only in childbirths after 37 weeks of gestation. Fetal male gender (OR 3.29; 95 % CI 2.70-4.02), nulliparous pregnancy (OR 2.60; 95 % CI 2.15-3.15) and post-term gestational age (≥42 weeks) (OR 1.92; 95 % CI 1.47-2.48) were independently associated with the occurrence of ZigZag pattern. Among the three significant risk factors, clustering of two or three factors was associated with an increase of the ZigZag pattern occurrence risk to 5.0-16.4-fold (95 % CI 3.16-31.60). CONCLUSIONS ZigZag pattern occurred in term pregnancies after 37 weeks of gestation only. Fetal male gender, nulliparity and post-term pregnancy are significantly associated with ZigZag FHR pattern during the last two hours of labour. Identification of maternal, fetal and delivery-related variables are imperative in order to interpret correctly the findings of CTG and to prevent adverse neonatal outcome.
Collapse
Affiliation(s)
- Mikko Tarvonen
- Department of Obstetrics and Gynaecology, University of Helsinki, and Helsinki University Hospital, Finland.
| | - Petteri Hovi
- National Institute for Health and Welfare (THL), Helsinki, Finland; Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Finland
| | - Susanna Sainio
- Finnish Red Cross Blood Transfusion Service, Helsinki, Finland
| | - Piia Vuorela
- Health and Social Welfare Department, City of Vantaa, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Finland
| | - Kari Teramo
- Department of Obstetrics and Gynaecology, University of Helsinki, and Helsinki University Hospital, Finland
| |
Collapse
|
21
|
Lichtman Y, Wainstock T, Walfisch A, Sheiner E. The Significance of True Knot of the Umbilical Cord in Long-Term Offspring Neurological Health. J Clin Med 2020; 10:jcm10010123. [PMID: 33396487 PMCID: PMC7796317 DOI: 10.3390/jcm10010123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to study both the short- and long-term neurological implications in offspring born with confirmed knotting of the umbilical cord-"true knot of cord". In this population based cohort study, a comparison of perinatal outcome and long-term neurological hospitalizations was performed on the basis of presence or absence of true knot of cord. A Kaplan-Meier survival curve was constructed to compare the cumulative incidence of neurological hospitalizations between the study groups. Multivariable regression models were used to assess the independent association between true knot of cord, perinatal mortality and long term neurological related hospitalizations, while controlling for potential confounders. The study included 243,639 newborns, of them 1.1% (n = 2606) were diagnosed with true knot of the umbilical cord. Higher rates of intrauterine fetal demise (IUFD) were noted in the exposed group, a finding which remained significant in the multivariable generalized estimation equation, while controlling for confounders. The cumulative incidences of neurological hospitalizations over time were comparable between the groups. The Cox regression confirmed a lack of association between true knot of cord and total long term neurological related hospitalizations. While presence of true knot of the umbilical cord is associated with higher IUFD rates, in our population, however, its presence does not appear to impact the long term neurological health of exposed offspring.
Collapse
Affiliation(s)
- Yael Lichtman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Correspondence: (Y.L.); (E.S.); Tel.: +972-526-803-609 (Y.L.); Fax: +972-732-049-297 (Y.L.)
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Medical Center, Jerusalem 9112001, Israel;
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Correspondence: (Y.L.); (E.S.); Tel.: +972-526-803-609 (Y.L.); Fax: +972-732-049-297 (Y.L.)
| |
Collapse
|
22
|
Obsa MS, Shanka GM, Menchamo MW, Fite RO, Awol MA. Factors Associated with Apgar Score among Newborns Delivered by Cesarean Sections at Gandhi Memorial Hospital, Addis Ababa. J Pregnancy 2020; 2020:5986269. [PMID: 32395344 PMCID: PMC7199625 DOI: 10.1155/2020/5986269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Newborns can be assessed clinically using the Apgar score test to quickly and summarily assess the health of newborn physical condition immediately after delivery and to determine any immediate need for extra medical or emergency care. This study is aimed at assessing factors associated with Apgar score among newborns delivered by cesarean sections and factors associated with Apgar score. METHOD Institutional-based cohort study design was conducted. All eligible study participants were included. Training was given for data collectors and supervisors. Regular supervision and follow-up was made. Data was entered into Epi Info version 7 computer software by investigators and was transported to SPSS version 20 computer program for analysis. Bivariate and multivariate analysis was used to identify factors associated with Apgar score. RESULT A total 354 newborn babies were included into the study. Majority of baby had low Apgar score at one minute and high Apgar score at five minutes. About 30.2% of newborn baby had Apgar score below seven minutes. On the other hand, about 12.8% of all newborns had low Apgar score at five minutes. It had been found that those neonates who were born when skin incision to delivery time is greater than three minutes were about fourfolds more likely to have low Apgar score than those who were born when skin incision to delivery time is less than three minutes (AOR 3.645) (95% CI (0.116-26.421)). CONCLUSION Newborn babies have a low Apgar score at one minute as compared to five minutes. But low Apgar score at five minutes has long-term sequel. Therefore, it is very important to reduce factors associated with low Apgar score at both minutes.
Collapse
Affiliation(s)
| | | | | | | | - Meron Abrar Awol
- Addis Ababa University School of Anesthesia, Addis Ababa, Ethiopia
| |
Collapse
|
23
|
Grillo-Ardila CF, Bautista-Charry AA, Diosa-Restrepo M. Breech presentation delivery care: A review of childbirth semiology, mechanism and care. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:253-265. [PMID: 32142240 DOI: 10.18597/rcog.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/27/2019] [Indexed: 11/04/2022]
Abstract
Objective To review the concepts underlying breech presentation delivery as well as the semiology and the obstetric maneuvers contributing to a successful perinatal maternal outcome. Materials and methods Based on a hypothetical scenario to set the stage for a practical approach to the topic, an explanatory paper built on a narrative review is created in order to examine the principles related to diagnosis, mechanism of delivery and maternal care, emphasizing maneuvers to ease fetal extraction. Results Breech presentation delivery must be managed through the vaginal canal when already in the expulsion phase with fetal engagement. For diagnosis and care, it is essential to know the unique semiology and physiology of this condition as well as the obstetric maneuvers to facilitate an uncomplicated delivery. Results The mechanism of childbirth in breech presentation is complex and requires knowledge of its physiology and multiple obstetric maneuvers on the part of the obstetrician as well as the general practitioner, in order to ensure adequate care when there is no other option.
Collapse
Affiliation(s)
| | | | - Mariana Diosa-Restrepo
- Residente de tercer año de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia
| |
Collapse
|
24
|
Bergh C, Hiyoshi A, Eriksson M, Fall K, Montgomery S. Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence. Acta Paediatr 2019; 108:2001-2007. [PMID: 31140196 PMCID: PMC6851554 DOI: 10.1111/apa.14881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Abstract
Aim We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within‐siblings analysis was used to tackle unmeasured shared familial confounding. Methods We used a national cohort of 527 763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age of 18 years (17–20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed‐effects linear regression models adjusted for potential confounding factors. Results Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared with those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of −0.26 (−0.39, −0.13). The associations were no longer statistically significant when using within‐siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses. Conclusion The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.
Collapse
Affiliation(s)
- Cecilia Bergh
- Clinical Epidemiology and Biostatistics School of Medical Sciences Örebro University Örebro Sweden
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics School of Medical Sciences Örebro University Örebro Sweden
- Department of Public Health Sciences Stockholm University Stockholm Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics School of Medical Sciences Örebro University Örebro Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics School of Medical Sciences Örebro University Örebro Sweden
- Clinical Epidemiology Division Department of Medicine Karolinska University Hospital Solna Karolinska Institutet Stockholm Sweden
- Department of Epidemiology and Public Health University College London London UK
| |
Collapse
|
25
|
Razaz N, Cnattingius S, Joseph KS. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ 2019; 365:l1656. [PMID: 31064770 PMCID: PMC6503461 DOI: 10.1136/bmj.l1656] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity. DESIGN Population based cohort study. SETTING Sweden. PARTICIPANTS 1 551 436 non-malformed live singleton infants, born at term (≥37 weeks' gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes. EXPOSURES Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively. MAIN OUTCOME MEASURES Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated. RESULTS Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes. CONCLUSIONS In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).
Collapse
Affiliation(s)
- Neda Razaz
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics & Gynaecology, School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
26
|
Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. J Pediatr (Rio J) 2019; 95:194-200. [PMID: 29444451 DOI: 10.1016/j.jped.2017.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/15/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate. METHOD Data were extracted from a historical cohort with 15,879 live births. A model was used that included socioeconomic, behavioral, and health service use risk factors, as well as the Apgar score and biological factors. Risk factors were analyzed by hierarchical logistic regression. RESULTS Based on the multivariate analysis, socioeconomic factors showed no association with death. Insufficient prenatal consultations showed an OR of 3.25 (95% CI: 1.70-6.48) for death. Low birth weight (OR 8.42; 95% CI: 3.45-21.93); prematurity (OR 5.40; 95% CI: 2.22-13.88); malformations (OR 4.42; 95% CI: 1.37-12.43); and low Apgar score at the first (OR 6.65; 95% CI: 3.36-12.94) and at the fifth (OR 19.78; 95% CI: 9.12-44.50) minutes, were associated with death. CONCLUSION Differing from other studies, socioeconomic conditions were not associated with neonatal death. Insufficient prenatal consultations, low Apgar score, prematurity, low birth weight, and malformations showed an association, reinforcing the importance of prenatal access universalization and its integration with medium and high-complexity neonatal care services.
Collapse
Affiliation(s)
- Leandro Pereira Garcia
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil.
| | - Camila Mariano Fernandes
- Universidade Federal de Santa Catarina (UFSC), Departamento de Saúde Pública, Florianópolis, SC, Brazil
| | - Jefferson Traebert
- Universidade do Sul de Santa Catarina (UNISUL), Departamento de Ciências da Saúde, Palhoça, SC, Brazil
| |
Collapse
|
27
|
Garcia LP, Fernandes CM, Traebert J. Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
28
|
Modabbernia A, Sandin S, Gross R, Leonard H, Gissler M, Parner ET, Francis R, Carter K, Bresnahan M, Schendel D, Hornig M, Reichenberg A. Apgar score and risk of autism. Eur J Epidemiol 2019; 34:105-114. [PMID: 30291529 PMCID: PMC6373297 DOI: 10.1007/s10654-018-0445-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/19/2018] [Indexed: 12/27/2022]
Abstract
Low Apgar score has been associated with higher risk for several neurological and psychiatric disorders, including cerebral palsy and intellectual disability. Studies of the association between Apgar score and autism spectrum disorder (ASD) have been inconsistent. We aimed to investigate (1) the association between low Apgar score at 5 min and risk for ASD, and (2) the modifying effects of gestational age and sex on this association in the largest multinational database of ASD. We included prospective data from 5.5 million individuals and over 33,000 cases of ASD from Norway, Sweden, Denmark and Western Australia who were born between 1984 and 2007. We calculated crude and adjusted risk ratios (RR) with 95% confidence intervals (95% CIs) for the associations between low Apgar score and ASD. All analyses for ASD were repeated for autistic disorder (AD). We used interaction terms and stratified analysis to investigate the effects of sex, gestational age, and birth weight on the association. In fully adjusted models, low Apgar scores (1-3) (RR, 1.42; 95% CI, 1.16-1.74), and intermediate Apgar scores (4-6) (RR, 1.50; 95% CI, 1.36-1.65) were associated with a higher RR of ASD than optimal Apgar score (7-10). The point estimates for low (RR, 1.88; 95% CI, 1.41-2.51) and intermediate Apgar score (RR, 1.54; 95% CI, 1.32-1.81) were larger for AD than for ASD. This study suggests that low Apgar score is associated with higher risk of ASD, and in particular AD. We did not observe any major modifying effects of gestational age and sex, although there seems to be substantial confounding by gestational age and birth weight on the observed association.
Collapse
Affiliation(s)
- Amirhossein Modabbernia
- Department of Psychiatry and Seaver Autism Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy PLC, New York, NY, 10029, USA
- Seaver Autism Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sven Sandin
- Department of Psychiatry and Seaver Autism Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy PLC, New York, NY, 10029, USA.
- Seaver Autism Center, Icahn School of Medicine at Mount Sinai, New York, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Raz Gross
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
- Nordic School of Public Health, Gothenburg, Sweden
- Department of Child Psychiatry, Turku University and Turku University Hospital, Turku, Finland
| | - Erik T Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Richard Francis
- Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Kim Carter
- Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Michaeline Bresnahan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Diana Schendel
- Department of Public Health, Institute of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark
- Department of Economics and Business, National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Abraham Reichenberg
- Department of Psychiatry and Seaver Autism Center, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy PLC, New York, NY, 10029, USA
- Seaver Autism Center, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
29
|
Liang Q, Xiong F, Liang X, Zheng D, Su S, Wen Y, Wang X. Two successive cases of fetal harlequin ichthyosis: A case report. Exp Ther Med 2018; 17:449-452. [PMID: 30651820 DOI: 10.3892/etm.2018.6917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 12/23/2016] [Indexed: 11/05/2022] Open
Abstract
Harlequin ichthyosis (HI) is a genetic skin disorder characterized by thickening and splitting of the skin. In fetuses presenting with the disorder, the mortality rate is markedly high. A number of fetal HI cases have been documented. The present study reports a case of a pregnant woman who underwent two successive pregnancies at the ages of 35 and 36, respectively, with both fetuses presenting with HI. The first fetus was delivered alive though succumbed shortly after birth, while the second fetus was stillborn and birthed by induced labor. The fetuses exhibited typical features of fetal HI, including thick, platelike scaling and fissuring, which act as a nidus for infection. The present study is the first to report two cases of fetal HI from successive pregnancies in the same woman. Improved understanding of the genetic basis of HI indicates that genetic screening for candidate gene mutations related to HI, particularly mutations in the adenosine triphosphate binding-cassette transporter ABCA12, may prove beneficial in prenatal diagnosis. Establishing methods for early diagnosis of fetal HI may reduce the physical and mental distress to parents and relatives.
Collapse
Affiliation(s)
- Qianhong Liang
- Ultrasound Department, He Xian Memorial Hospital, Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Fu Xiong
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xuankun Liang
- Ultrasound Department, He Xian Memorial Hospital, Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Dongming Zheng
- Ultrasound Department, He Xian Memorial Hospital, Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Shuguang Su
- Ultrasound Department, He Xian Memorial Hospital, Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Yunjie Wen
- Guangzhou Huayin Medical Laboratory Center, Co., Ltd., Guangzhou, Guangdong 510663, P.R. China
| | - Xiaodan Wang
- Guangzhou Huayin Medical Laboratory Center, Co., Ltd., Guangzhou, Guangdong 510663, P.R. China
| |
Collapse
|
30
|
Mendis R, Flatley C, Kumar S. Maternal demographic factors associated with emergency caesarean section for non-reassuring foetal status. J Perinat Med 2018; 46:641-647. [PMID: 29171962 DOI: 10.1515/jpm-2017-0142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/31/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to determine maternal and obstetric factors associated with emergency caesarean section (CS) for non-reassuring foetal status (NRFS). MATERIALS AND METHODS This was a retrospective analysis of term singleton births between January 2007 and December 2015 at the Mater Mother's Hospital in Brisbane. The study group comprised all cases of emergency CS for NRFS, and the control cohort comprised all other births meeting the inclusion criteria but excluding those in the study cohort. RESULTS Over the study period, there were 74,177 births fulfilling the inclusion criteria. The overall rate of emergency CS for NRFS was 4.2% (3132/74,177). Multivariate analysis showed that being overweight and obese, Indian and "other" ethnicity, artificial reproductive techniques, smoking, induction of labour and gestation at 39-42 weeks were associated with an increased risk, whereas being underweight, female sex, hypertension and birth without labour conferred a lower risk. CONCLUSION Many maternal and obstetric factors were associated with emergency CS for NRFS and influenced adverse perinatal outcomes. Recognition of these risk factors could help risk stratify women prior to labour.
Collapse
Affiliation(s)
- Ramali Mendis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Christopher Flatley
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- School of Medicine, The University of Queensland, Brisbane, Australia.,Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia, Tel.: +617 31638844
| |
Collapse
|
31
|
Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ 2018; 360:k207. [PMID: 29437691 PMCID: PMC5802319 DOI: 10.1136/bmj.k207] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks. DESIGN, SETTING, AND PARTICIPANTS Population based cohort study in Sweden, including 1 213 470 non-malformed live singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries. EXPOSURES Apgar scores at five and 10 minutes. MAIN OUTCOME MEASURE Cerebral palsy and epilepsy diagnosed up to 16 years of age. Adjusted hazard ratios were calculated, along with 95% confidence intervals. RESULTS 1221 (0.1%) children were diagnosed as having cerebral palsy and 3975 (0.3%) as having epilepsy. Compared with children with an Apgar score of 10 at five minutes, the adjusted hazard ratio for cerebral palsy increased steadily with decreasing Apgar score: from 1.9 (95% confidence interval 1.6 to 2.2) for an Apgar score of 9 to 277.7 (154.4 to 499.5) for an Apgar score of 0. Similar and even stronger associations were obtained between Apgar scores at 10 minutes and cerebral palsy. Associations between Apgar scores and epilepsy were less pronounced, but increased hazard ratios were noted in infants with a five minute Apgar score of 7 or less and a 10 minute Apgar score of 8 or less. Compared with infants with an Apgar of 9-10 at both five and 10 minutes, hazard ratios of cerebral palsy and epilepsy were higher among infants with a five minute Apgar score of 7-8 and a 10 minute Apgar score of 9-10. CONCLUSION Risks of cerebral palsy and epilepsy are inversely associated with five minute and 10 minute Apgar scores across the entire range of Apgar scores.
Collapse
Affiliation(s)
- Martina Persson
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Neda Razaz
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Neuropediatric Unit, Karolinska Institutet, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital of British Columbia
| | - Sven Cnattingius
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| |
Collapse
|
32
|
Smirnova A, Ravelli ACJ, Stalmeijer RE, Arah OA, Heineman MJ, van der Vleuten CPM, van der Post JAM, Lombarts KMJMH. The Association Between Learning Climate and Adverse Obstetrical Outcomes in 16 Nontertiary Obstetrics-Gynecology Departments in the Netherlands. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1740-1748. [PMID: 28953570 DOI: 10.1097/acm.0000000000001964] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the association between learning climate and adverse perinatal and maternal outcomes in obstetrics-gynecology departments. METHOD The authors analyzed 23,629 births and 103 learning climate evaluations from 16 nontertiary obstetrics-gynecology departments in the Netherlands in 2013. Multilevel logistic regressions were used to calculate the odds of adverse perinatal and maternal outcomes, by learning climate score tertile, adjusting for maternal and department characteristics. Adverse perinatal outcomes included fetal or early neonatal mortality, five-minute Apgar score < 7, or neonatal intensive care unit admission for ≥ 24 hours. Adverse maternal outcomes included postpartum hemorrhage and/or transfusion, death, uterine rupture, or third- or fourth-degree perineal laceration. Bias analyses were conducted to quantify the sensitivity of the results to uncontrolled confounding and selection bias. RESULTS Learning climate scores were significantly associated with increased odds of adverse perinatal outcomes (aOR 2.06, 95% CI 1.14-3.72). Compared with the lowest tertile, departments in the middle tertile had 46% greater odds of adverse perinatal outcomes (aOR 1.46, 95% CI 1.09-1.94); departments in the highest tertile had 69% greater odds (aOR 1.69, 95% CI 1.24-2.30). Learning climate was not associated with adverse maternal outcomes (middle vs. lowest tertile: OR 1.04, 95% CI 0.93-1.16; highest vs. lowest tertile: OR 0.98, 95% CI 0.88-1.10). CONCLUSIONS Learning climate was associated with significantly increased odds of adverse perinatal, but not maternal, outcomes. Research in similar clinical contexts is needed to replicate these findings and explore potential mechanisms behind these associations.
Collapse
Affiliation(s)
- Alina Smirnova
- A. Smirnova is a PhD candidate, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands, and researcher, Professional Performance Research Group, Institute for Education and Training, Academic Medical Center, Amsterdam, The Netherlands. A.C.J. Ravelli is epidemiologist and assistant professor, Departments of Medical Informatics and Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. R.E. Stalmeijer is assistant professor, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands. O.A. Arah is professor, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. M.J. Heineman is professor, Board of Directors, Academic Medical Center, Amsterdam, The Netherlands. C.P.M. van der Vleuten is professor and scientific director, School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands. J.A.M. van der Post is professor, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Institute for Education and Training, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|