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Moran P, Sullivan K, Zanelli SA, Burnsed J. Single-Center Experience with Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy in Infants with <36 Weeks' Gestation. Am J Perinatol 2024; 41:1680-1687. [PMID: 38262469 DOI: 10.1055/a-2251-6317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in neonates. Therapeutic hypothermia (TH) has improved outcomes and mortality in infants with >36 weeks' gestational age (GA) with moderate-to-severe HIE. There are limited data on the safety and efficacy of TH in preterm infants with HIE. This study describes our experience and examines the safety of TH in neonates with <36 weeks' GA. STUDY DESIGN A single-center, retrospective study of preterm neonates born at <36 weeks' GA with moderate-to-severe HIE and treated with TH, compared to a cohort of term neonates with HIE (≥37 weeks' GA), was conducted. The term cohort was matched for degree of background abnormality on electroencephalogram, sex, inborn versus outborn status, and birth year. Medical records were reviewed for pregnancy and delivery complications, need for transfusion, sedation and antiseizure medications, electroencephalography and imaging findings, and in-hospital mortality. RESULTS Forty-two neonates born at <36 weeks' GA with HIE received TH between 2005 and 2022. Data from 42 term neonates were analyzed for comparison. The average GA of the preterm cohort was 34.6 weeks and 39.3 weeks for the term cohort. Apgar scores, degree of acidosis, and need for blood product transfusions were similar between groups. Preterm infants were more likely to require inotropic support (55 vs. 29%, p = 0.026) and hydrocortisone (36 vs. 12%, p = 0.019) for hypotension. The proportion of infants without evidence of injury on magnetic resonance imaging was similar in both groups: 43 versus 50% in preterm and term infants, respectively. No significant difference was found in mortality between groups. CONCLUSION In this single-center cohort, TH in preterm infants appears to be as safe as in term infants, with no significant increase in intracranial bleeds or mortality. Preterm infants more frequently required inotropes and steroids for hypotension. Further research is needed to determine efficacy of TH in preterm infants. KEY POINTS · TH is used off-protocol in preterm infants.. · Preterm and term infants have similar mortality.. · Preterm cohort required more inotropic support..
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Affiliation(s)
- Patricia Moran
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelsey Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Santina A Zanelli
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Jennifer Burnsed
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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Künstle N, Gorlanova O, Marten A, Müller L, Sharma P, Röösli M, Sinues P, Schär P, Schürmann D, Rüttimann C, Da Silva Sena CR, Nahum U, Usemann J, Steinberg R, Yammine S, Schulzke S, Latzin P, Frey U. Differences in autophagy marker levels at birth in preterm vs. term infants. Pediatr Res 2024:10.1038/s41390-024-03273-6. [PMID: 38811718 DOI: 10.1038/s41390-024-03273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Preterm infants are susceptible to oxidative stress and prone to respiratory diseases. Autophagy is an important defense mechanism against oxidative-stress-induced cell damage and involved in lung development and respiratory morbidity. We hypothesized that autophagy marker levels differ between preterm and term infants. METHODS In the prospective Basel-Bern Infant Lung Development (BILD) birth cohort we compared cord blood levels of macroautophagy (Beclin-1, LC3B), selective autophagy (p62) and regulation of autophagy (SIRT1) in 64 preterm and 453 term infants. RESULTS Beclin-1 and LC3B did not differ between preterm and term infants. However, p62 was higher (0.37, 95% confidence interval (CI) 0.05;0.69 in log2-transformed level, p = 0.025, padj = 0.050) and SIRT1 lower in preterm infants (-0.55, 95% CI -0.78;-0.31 in log2-transformed level, padj < 0.001). Furthermore, p62 decreased (padj-value for smoothing function was 0.018) and SIRT1 increased (0.10, 95% CI 0.07;0.13 in log2-transformed level, padj < 0.001) with increasing gestational age. CONCLUSION Our findings suggest differential levels of key autophagy markers between preterm and term infants. This adds to the knowledge of the sparsely studied field of autophagy mechanisms in preterm infants and might be linked to impaired oxidative stress response, preterm birth, impaired lung development and higher susceptibility to respiratory morbidity in preterm infants. IMPACT To the best of our knowledge, this is the first study to investigate autophagy marker levels between human preterm and term infants in a large population-based sample in cord blood plasma This study demonstrates differential levels of key autophagy markers in preterm compared to term infants and an association with gestational age This may be linked to impaired oxidative stress response or developmental aspects and provide bases for future studies investigating the association with respiratory morbidity.
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Affiliation(s)
- Noëmi Künstle
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Andrea Marten
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Loretta Müller
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland and University of Basel, Basel, Switzerland
| | - Pablo Sinues
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Primo Schär
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - David Schürmann
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Céline Rüttimann
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carla Rebeca Da Silva Sena
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Priority Research Centre GrowUpWell® and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Uri Nahum
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Jakob Usemann
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ruth Steinberg
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Yammine
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Schulzke
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
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3
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Tuttle Z, Roberts C, Davis P, Malhotra A, Tan K, Bhatia R, Zhou L, Baker E, Hodgson K, Blank D. Combining activity and grimace scores reflects perinatal stability in infants <32 weeks gestational age. Pediatr Res 2024:10.1038/s41390-024-03130-6. [PMID: 38519793 DOI: 10.1038/s41390-024-03130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Over 95% of infants less than 32 weeks gestational age-very preterm infants (VPTI)-require cardiorespiratory support at birth. Clinical condition at birth is assessed by the Apgar score, but the precision and accuracy of activity and grimace has not been evaluated. We hypothesised activity and grimace could predict the level of cardiorespiratory support required for stabilisation. METHODS Two hundred twenty-nine videos of VPTI resuscitations at Monash Children's Hospital and The Royal Women's Hospital, Melbourne were evaluated, with 78 videos eligible for assessment. Activity and grimace were scored (0, 1, or 2) by seven consultant neonatologists, with inter-rater reliability assessed. Activity and grimace were correlated with the maximum level of cardiorespiratory support required for stabilisation. RESULTS Kendall's Coefficient of Concordance (W) showed strong interobserver agreement for activity (W = 0.644, p < 0.001) and grimace (W = 0.722, p < 0.001). Neither activity nor grimace independently predicted the level of cardiorespiratory support required. Combining activity and grimace showed non-vigorous infants (combined score <2) received more cardiorespiratory support than vigorous (combined score ≥ 2). CONCLUSION Scoring of activity and grimace was consistent between clinicians. Independently, activity and grimace did not correlate with perinatal stabilisation. Combined scoring showed non-vigorous infants had greater resuscitation requirements. IMPACT Our study evaluates the precision and accuracy of activity and grimace to predict perinatal stability, which has not been validated in infants <32 weeks gestational age. We found strong score agreement between assessors, indicating video review is a practical and precise method for grading of activity and grimace. Combined scoring to allow a dichotomous evaluation of infants as non-vigorous or vigorous showed the former group required greater cardiorespiratory support at birth.
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Affiliation(s)
- Zachary Tuttle
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
| | - Calum Roberts
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Peter Davis
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Atul Malhotra
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Kenneth Tan
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Risha Bhatia
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
| | - Lindsay Zhou
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
| | - Elizabeth Baker
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Kate Hodgson
- Women's Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Douglas Blank
- The Ritchie Centre, Monash University, Clayton, VIC, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
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Bala JJ, Bala JD, Pell JP, Fleming M. Association between 5-min Apgar score and attention deficit hyperactivity disorder: a Scotland-wide record linkage study of 758,423 school children. BMC Psychiatry 2023; 23:794. [PMID: 37907891 PMCID: PMC10619264 DOI: 10.1186/s12888-023-05217-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) affects around 1 in 20 children and is associated with life-long sequelae. Previous studies of the association between Apgar score and ADHD have reported inconsistent findings. METHODS Record linkage of maternity, prescribing and school pupil census databases was used to conduct a population e-cohort study of singleton children born in Scotland and attending school in Scotland at any point between 2009 and 2013. Binary logistic regression analysis was used to investigate the association between 5-min Apgar score and treated ADHD adjusting for sociodemographic and maternity confounders. RESULTS Of the 758,423 children, 7,292 (0.96%) received ADHD medication. The results suggested a potential dose-response relationship between Apgar score and treated ADHD independent of confounders. Referent to an Apgar score of 10, risk of treated ADHD was higher for scores of 0-3 (adjusted OR 1.76, 95% CI 1.32-2.34), 4-6 (adjusted OR 1.50, 95% CI 1.21-1.86) and even 7-9 (adjusted OR 1.26, 95% CI 1.18-1.36) which are traditionally considered within the normal range. CONCLUSIONS In addition to reinforcing the need to maximise Apgar score through good obstetric practice, the findings suggest that Apgar score may be useful in predicting future risk of ADHD and therefore facilitating early diagnosis and treatment.
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Affiliation(s)
- Jecintha J Bala
- School of Health and Wellbeing, University of Glasgow, Glasgow, 90 Byres Road, G12 8TB, UK
| | - Joel D Bala
- Hospital At Home, NHS Central London Community HealthCare Trust, London, SW17 9SH, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, 90 Byres Road, G12 8TB, UK
| | - Michael Fleming
- School of Health and Wellbeing, University of Glasgow, Glasgow, 90 Byres Road, G12 8TB, UK.
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Almuqbil M, Alrumayyan Y, Alattas S, Baarmah D, AlTuwaijri W, AlRumayyan A, AlRifai MT, Al Madhi A, Al-shehri H, Alsaif S. Neonatal seizures: Etiologies, clinical characteristics, and radiological features: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35185. [PMID: 37713864 PMCID: PMC10508452 DOI: 10.1097/md.0000000000035185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
Seizures are a common clinical indication of central nervous system damage or abnormality in neonates. We aimed to identify the etiologies, clinical characteristics, and radiological features of neonatal seizures. This is a cross-sectional, retrospective, descriptive study using data obtained from the neonatal intensive care unit in King Abdulaziz Medical City (KAMC), a governmental, academic tertiary hospital in Riyadh, Saudi Arabia. The population of interest were neonates diagnosed with a neonatal seizure at KAMC between April 2015 and March 2019. A total of 61 patients with neonatal seizures were included in the study. The most common etiology was hypoxic-ischemic encephalopathy (43%). A total of 32 patients were full-term (52.5%). Around one-fifth of the study sample (21.3%) had a family history of neonatal seizures. Around 43.0% of the patients had epilepsy episodes. More than half of the patients (57.0%) were on one anti-seizure medication. Patients were followed up after 1 year, they had multiple comorbidities, including developmental delay, epilepsy, and cerebral palsy. Developmental delay was identified in 62.3% of the patients. A total of 19 patients have passed away (31%). Neonatal seizures are a common manifestation of neurologic disorders in neonates and are associated with high morbidity and mortality. Therefore, early identification of seizure etiology and proper management may help to improve the outcome.
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Affiliation(s)
- Mohammed Almuqbil
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia
| | - Yousof Alrumayyan
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Shahad Alattas
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Duaa Baarmah
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Waleed AlTuwaijri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Ahmed AlRumayyan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Mohammed Tala AlRifai
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdullah Specialist Children Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Asma Al Madhi
- Department of Pediatric Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan Al-shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Saif Alsaif
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Department of Neonatology, King Abdulaziz Medical City (KAMC), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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Miles KG, Liu J, Tseng SY, DeFranco EA, Divanovic AA, Jones HN, Ollberding NJ, Cnota JF. Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease. J Am Heart Assoc 2023; 12:e028774. [PMID: 37260029 PMCID: PMC10381992 DOI: 10.1161/jaha.122.028774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.
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Affiliation(s)
| | - James Liu
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and GynecologyUniversity of CincinnatiCincinnatiOH
| | | | - Emily A. DeFranco
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and GynecologyUniversity of CincinnatiCincinnatiOH
| | | | - Helen N. Jones
- Department of Physiology and AgingUniversity of FloridaGainesvilleFL
| | - Nicholas J. Ollberding
- Division of Biostatistics and EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiOH
| | - James F. Cnota
- The Heart InstituteCincinnati Children’s HospitalCincinnatiOH
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7
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Michel AD, Lowe NK. Accuracy and Interrater Agreement of Registered Nurses' Assignment of Apgar Scores to Standardized Clinical Vignettes. Clin Nurs Res 2023; 32:452-462. [PMID: 36788427 DOI: 10.1177/10547738231155266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The purpose of our study was to test whether registered nurses assign the correct Apgar score when provided all pertinent data, whether they assign an Apgar score even if all pertinent data are not provided, and to evaluate the Apgar score's interrater agreement. We conducted a REDCap survey and provided nurses with color photograph/vignette combinations of neonates, some of which lacked pertinent data points needed to correctly assign Apgar scores. Over 90% of study participants assigned Apgar scores even if data points for heart rate or respiratory effort were omitted. Participants' correct assignment of the component score for respiratory effort was affected by the description of the respiratory effort and whether neonatal heart rate was known. Interrater agreement was generally low to moderate. Our findings are consistent with earlier findings and support the conclusion that the Apgar score requires significant revision or needs to be retired and replaced.
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8
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杨 旻, 汪 吉. [Perinatal risk factors for the occurrence of singleton apparently stillborn infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:18-24. [PMID: 36655659 PMCID: PMC9893824 DOI: 10.7499/j.issn.1008-8830.2207108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants. METHODS This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants. RESULTS The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05). CONCLUSIONS Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.
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9
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Lin L, Liu G, Li Y, Shi B, Su Z, Jia C, Wu F. Apgar scores correlate with survival rate at discharge in extremely preterm infants with gestational age of 25-27 weeks. Braz J Med Biol Res 2022; 55:e12403. [PMID: 36477954 PMCID: PMC9728629 DOI: 10.1590/1414-431x2022e12403] [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: 08/29/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
Low Apgar score is associated with increased risk of death in preterm or full-term infants. However, the use of Apgar score to assess extremely preterm (EP) infants is controversial. In this study, we characterized the distribution of Apgar scores in EP infants with gestational age between 25 and 27 weeks, and investigated the association of Apgar score with survival rate at discharge by analyzing the clinical data of the EP infants discharged between January 2008 and December 2017 from 26 neonatal intensive care units in Guangdong Province, China. A total of 1567 infants with gestational age of 26.84±0.79 weeks and birth weight of 951±169 grams were involved in our study. The Apgar score increased with gestational age from 25 to 27 weeks and with time from birth from 1 to 10 min. The survival rate increased with a higher Apgar score, but no significant difference was found for 1-min Apgar score and the survival rate between infants with 25 or 26 weeks of gestation or 5-min Apgar score in infants with 25 weeks of gestation. The Apgar score is associated with survival of EP infants.
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Affiliation(s)
- Lili Lin
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guosheng Liu
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Ying Li
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Bijun Shi
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiwen Su
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chunhong Jia
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Fan Wu
- Department of Neonatology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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10
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Clark J, Bulka CM, Martin CL, Roell K, Santos HP, O’Shea TM, Smeester L, Fry R, Dhingra R. Placental epigenetic gestational aging in relation to maternal sociodemographic factors and smoking among infants born extremely preterm: a descriptive study. Epigenetics 2022; 17:2389-2403. [PMID: 36134874 PMCID: PMC9665142 DOI: 10.1080/15592294.2022.2125717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022] Open
Abstract
Social determinants of health (SDoH) are defined as the conditions in which people are born, grow, live, work, and age. The distribution of these conditions is influenced by underlying structural factors and may be linked to adverse pregnancy outcomes through epigenetic modifications of gestational tissues. A promising modification is epigenetic gestational age (eGA), which captures 'biological' age at birth. Measuring eGA in placenta, an organ critical for foetal development, may provide information about how SDoH 'get under the skin' during pregnancy to influence birth outcomes and ethnic/racial disparities. We examined relationships of placental eGA with sociodemographic factors, smoking, and two key clinical outcomes: Apgar scores and NICU length of stay. Using the Robust Placental Clock, we estimated eGA for placental samples from the Extremely Low Gestational Age Newborns cohort (N = 408). Regression modelling revealed smoking during pregnancy was associated with placental eGA acceleration (i.e., eGA higher than chronologic gestational age). This association differed by maternal race: among infants born to mothers racialized as Black, we observed greater eGA acceleration (+0.89 week, 95% CI: 0.38, 1.40) as compared to those racialized as white (+0.27 week, 95% CI: -0.06, 0.59). Placental eGA acceleration was also correlated with shorter NICU lengths of stay, but only among infants born to mothers racialized as Black (-0.08 d/week-eGA, 95% CI: -0.12, -0.05). Together, these observed associations suggest that interpretations of epigenetic gestational aging may be tissue-specific.
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Affiliation(s)
- Jeliyah Clark
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Catherine M. Bulka
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Chantel L. Martin
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kyle Roell
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, NC, USA
| | - Hudson P. Santos
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, NC, USA
- Biobehavioral Lab, School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - T. Michael O’Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa Smeester
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca Fry
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, NC, USA
- Curriculum in Toxicology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Radhika Dhingra
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, University of North Carolina, Chapel Hill, NC, USA
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11
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Bonifacio SL, Chalak LF, Van Meurs KP, Laptook AR, Shankaran S. Neuroprotection for hypoxic-ischemic encephalopathy: Contributions from the neonatal research network. Semin Perinatol 2022; 46:151639. [PMID: 35835616 DOI: 10.1016/j.semperi.2022.151639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Therapeutic hypothermia (TH) is now well established as the standard of care treatment for moderate to severe neonatal encephalopathy secondary to perinatal hypoxic ischemic encephalopathy (HIE) in infants ≥36 weeks gestation in high income countries. The Neonatal Research Network (NRN) contributed greatly to the study of TH as a neuroprotectant with three trials now completed in infants ≥36 weeks gestation and the only large randomized-controlled trial of TH in preterm infants now in the follow-up phase. Data from the first NRN TH trial combined with data from other large trials of TH affirm the safety and neuroprotective qualities of TH and highlight the importance of providing TH to all infants who qualify. In this review we will highlight the findings of the three NRN trials of TH in the term infant population and the secondary analyses that continue to inform the care of patients with HIE.
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Affiliation(s)
- Sonia Lomeli Bonifacio
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Krisa P Van Meurs
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Abbot R Laptook
- Department of Pediatrics, Women and Infants' Hospital of Rhode Island, Providence, RI, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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12
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Bando N, Walton K, O'Connor DL, Janus M, Unger SL. Examination of school readiness and factors related to developmental vulnerability in children born very low birth weight. Child Care Health Dev 2022; 49:444-455. [PMID: 36070087 DOI: 10.1111/cch.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/02/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children born very low birth weight (VLBW) experience school struggles with preparedness requiring adequate physical, social, behavioural, cognitive and communication skills. A global assessment of proficiency is necessary to identify those at risk in any such area and direct early intervention accordingly. Study objectives were to characterize developmental vulnerability and school readiness scores in these key domains in a sample of children born VLBW versus their provincial public school system peers and identify early-life infant and parent factors related to suboptimal school readiness. METHODS The Early Development Instrument teacher assessments of school readiness were collected for a Canadian VLBW sample (NCT02759809). Comparisons between children born VLBW and peers were made. Group differences between children born VLBW considered vulnerable (<10th percentile, not developmentally ready for learning) and not vulnerable were tested and linear regression explored associations between early-life factors and domain scores. RESULTS Of 77 available Early Development Instrument assessments, median (interquartile range) assessment age was 6.0 (5.7, 6.2) years, birth weight 950 (793, 1250) grammes and birth gestation 27.4 (25.6, 29.7) weeks. A higher proportion of children born VLBW versus peers exhibited vulnerability in Physical Health and Well-being (24.7% vs. 16.1%, p = 0.04), Communication Skills and General Knowledge (23.4% vs. 10.2%, p = 0.0001) and vulnerability in ≥2 domains (26.0% vs. 14.4%, p = 0.004). Children born VLBW classified as vulnerable versus not vulnerable had lower birth gestation and 5-min Apgar. Adjusted regression models found Apgar <7 associated with lower scores for Physical Health and Well-being (-0.86; 95%CI: -1.71, -0.00; p = 0.049), Social Competence (-1.77; 95%CI: -2.92, -0.62; p = 0.003), Emotional Maturity (-1.55; 95%CI: -2.43, -0.66; p = 0.0009) and Communication Skills and General Knowledge (-1.63; 95%CI: -3.19, -0.06; p = 0.04). CONCLUSIONS This VLBW sample exhibited poor school readiness in multiple domains. Identification of lower birth gestation and Apgar may assist targeted early interventions to mitigate vulnerability.
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Affiliation(s)
- Nicole Bando
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Walton
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Magdalena Janus
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada.,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics, University of Toronto, Toronto, Ontario, Canada
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13
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Shah PS, Norman M, Rusconi F, Kusuda S, Reichman B, Battin M, Bassler D, Modi N, Hakansson S, Yang J, Lee SK, Helenius K, Vento M, Lehtonen L, Adams M, Isayama T, Lui K, Gagliardi L. Five-minute Apgar score and outcomes in neonates of 24-28 weeks' gestation. Arch Dis Child Fetal Neonatal Ed 2022; 107:437-446. [PMID: 34782368 DOI: 10.1136/archdischild-2021-322230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess associations between 5 min Apgar score and mortality and severe neurological injury (SNI) and to report test characteristics in preterm neonates. DESIGN, SETTING AND PATIENTS Retrospective cohort study of neonates 240 to 286 weeks' gestation born between 2007 and 2016 and admitted to neonatal units in 11 high-income countries. EXPOSURE 5 min Apgar score. MAIN OUTCOME MEASURES In-hospital mortality and SNI defined as grade 3 or 4 periventricular/intraventricular haemorrhage or periventricular leukomalacia. Outcome rates were calculated for each Apgar score and compared after adjustment. The diagnostic characteristics and ORs for each value from 0 versus 1-10 to 0-9 versus 10, with 1-point increments were calculated. RESULTS Among 92 412 included neonates, as 5 min Apgar score increased from 0 to 10, mortality decreased from 60% to 8%. However, no clear increasing or decreasing pattern was identified for SNI. There was an increase in sensitivity and decrease in specificity for both mortality and SNI associated with increasing scores. The Apgar score alone had an area under the curve of 0.64 for predicting mortality, which increased to 0.73 with the addition of gestational age. CONCLUSIONS In neonates of 24-28 weeks' gestation admitted to neonatal units, higher 5 min Apgar score was associated with lower mortality in a graded manner, while the association with SNI remained relatively constant at all scores. Among survivors, low Apgar scores did not predict SNI.
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Affiliation(s)
- Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada .,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's University Hospital and Regional Health Agency, Florence, Italy
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Malcolm Battin
- Department of Neonatology, Auckland District Health Board, Auckland, New Zealand
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Stellan Hakansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Jie Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Maximo Vento
- Division of Neonatology, Health Research Institute La Fe, Valencia, Spain
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia
| | - Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Italy
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14
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Tarimo CS, Bhuyan SS, Zhao Y, Ren W, Mohammed A, Li Q, Gardner M, Mahande MJ, Wang Y, Wu J. Prediction of low Apgar score at five minutes following labor induction intervention in vaginal deliveries: machine learning approach for imbalanced data at a tertiary hospital in North Tanzania. BMC Pregnancy Childbirth 2022; 22:275. [PMID: 35365129 PMCID: PMC8976377 DOI: 10.1186/s12884-022-04534-0] [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: 05/18/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Prediction of low Apgar score for vaginal deliveries following labor induction intervention is critical for improving neonatal health outcomes. We set out to investigate important attributes and train popular machine learning (ML) algorithms to correctly classify neonates with a low Apgar scores from an imbalanced learning perspective. Methods We analyzed 7716 induced vaginal deliveries from the electronic birth registry of the Kilimanjaro Christian Medical Centre (KCMC). 733 (9.5%) of which constituted of low (< 7) Apgar score neonates. The ‘extra-tree classifier’ was used to assess features’ importance. We used Area Under Curve (AUC), recall, precision, F-score, Matthews Correlation Coefficient (MCC), balanced accuracy (BA), bookmaker informedness (BM), and markedness (MK) to evaluate the performance of the selected six (6) machine learning classifiers. To address class imbalances, we examined three widely used resampling techniques: the Synthetic Minority Oversampling Technique (SMOTE) and Random Oversampling Examples (ROS) and Random undersampling techniques (RUS). We applied Decision Curve Analysis (DCA) to evaluate the net benefit of the selected classifiers. Results Birth weight, maternal age, and gestational age were found to be important predictors for the low Apgar score following induced vaginal delivery. SMOTE, ROS and and RUS techniques were more effective at improving “recalls” among other metrics in all the models under investigation. A slight improvement was observed in the F1 score, BA, and BM. DCA revealed potential benefits of applying Boosting method for predicting low Apgar scores among the tested models. Conclusion There is an opportunity for more algorithms to be tested to come up with theoretical guidance on more effective rebalancing techniques suitable for this particular imbalanced ratio. Future research should prioritize a debate on which performance indicators to look up to when dealing with imbalanced or skewed data. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04534-0.
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Affiliation(s)
- Clifford Silver Tarimo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China.,Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, P.O. Box 2958, Dar es Salaam, Tanzania
| | - Soumitra S Bhuyan
- Rutgers University-New Brunswick, Edward J. Bloustein, School of Planning and Public Policy, New Brunswick, USA
| | - Yizhen Zhao
- Luoyang Orthopedic Traumatological Hospital of Henan Province, Luoyang, China
| | - Weicun Ren
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China.,College of Sanquan, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Akram Mohammed
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Marilyn Gardner
- Department of Public Health, Western Kentucky University, 1906 College Heights Blvd, Bowling Green, KY, 42101, USA
| | - Michael Johnson Mahande
- Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Tanzania
| | - Yuhui Wang
- Centre for Financial and Corporate Integrity, Coventry University, Coventry, UK
| | - Jian Wu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China. .,Henan Province Engineering Research Center of Health Economics & Health Technology Assessment, Henan Province, China.
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15
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Low Five-Minute Apgar Score and Neurological Morbidities: Does Prematurity Modify the Association? J Clin Med 2022; 11:jcm11071922. [PMID: 35407530 PMCID: PMC8999413 DOI: 10.3390/jcm11071922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: We aimed to study whether a low 5 min Apgar score is associated with pediatric neurological morbidities throughout childhood. (2) Methods: A population-based retrospective cohort study was conducted. The exposed group was defined as offspring with a 5 min Apgar score <7, and the remaining offspring served as the comparison group. The primary outcome was defined as pediatric hospitalizations with any neurological morbidity. Multivariable survival models were used to evaluate the association between the exposure and outcome while adjusting for potential confounders. Additional models were used to study this association separately among term- and preterm-born offspring. (3) Results: The study population included 349,385 singletons born between the years 1991 and 2021, 0.6% (n = 2030) of whom had a 5 min Apgar score <7 (exposed). The cohort was followed for up to 18 years (median ~ 10.6). The incidence of neurological morbidity-related hospitalizations was higher among the exposed group versus the unexposed group (11.3% versus 7.5%, hazard ratio = 1.84; 95%CI 1.58−2.13). A low 5 min Apgar score remained a significant risk factor for neurological hospitalizations after adjusting for preterm delivery, maternal age, hypertension during pregnancy, gestational diabetes mellitus, chorioamnionitis, and delivery mode (adjusted hazard ratio = 1.61; 95%CI 1.39−1.87). However, after modeling term and preterm offspring separately, a low 5 min Apgar score was independently associated with neurological hospitalizations only among offspring born at term (adjusted hazard ratio = 1.16; 95%CI 0.87−1.55 and 1.70; 95%CI 1.42−2.02 for preterm and term offspring, respectively). (4) Conclusions: A low 5 min Apgar score is independently associated with childhood neurological morbidity, specifically among term-born offspring. Although not designed to identify risk for long-term health complications, Apgar scores may be a marker of risk for short- and long-term neurological morbidities among term newborns.
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16
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Awoyesuku P, John D, Josiah A, Sapira-Ordu L. Maternal, obstetric, and foetal risk factors for perinatal asphyxia: Prevalence and outcome at a tertiary hospital in Port Harcourt, Nigeria. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_197_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Hira S, Ban R, Ogawa S, Sakai K, Takitani K, Ashida A. Antenatal mgnesium sulfate and ritodrine increased potassium levels in preterm infants: A cohort study. Pediatr Int 2022; 64:e15315. [PMID: 36331237 DOI: 10.1111/ped.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 07/08/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ritodrine and magnesium sulfate are administered to prevent preterm labor. Magnesium sulfate is also administered to prevent preeclampsia. These drugs have been reported to increase potassium levels in pregnant women and neonates. The aim of this study was to investigate the relationship between potassium levels in preterm infants and antenatal treatment. METHODS This prospective cohort study was conducted at Saiseikai Suita Hospital. Preterm infants born at <35 weeks' gestation between October 2012 and September 2014 were recruited and divided into four groups based on the antenatal treatment their mothers received. Serum and urine electrolyte levels at birth and serum potassium levels 1 day after birth were measured. RESULTS The mothers of 16 infants received no antenatal treatment (condition C); the mothers of 29 infants received antenatal ritodrine (R); the mothers of seven infants received magnesium sulfate (M); and the mothers of 15 infants received both magnesium sulfate and ritodrine (M + R). At birth, potassium levels were similar among the four groups. However, potassium levels a day after birth were significantly higher in the M + R group than in the other groups: median (min.-max.) mEq/L 4.8 (3.8-6.2), 4.8 (3.6-6.0), and 4.4 (3.8-5.9) vs. 5.8 (4.9-7.2), in the C, R, and M groups versus the M + R group, respectively (P < 0.01). Significantly more infants in the M + R group exhibited a fractional excretion of potassium of <10% compared with those in the other groups. CONCLUSION The increased potassium levels we observe in preterm infants of mothers who received antenatal magnesium sulfate and ritodrine administration on postnatal day 1 warrant monitoring by neonatologists.
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Affiliation(s)
- Seigo Hira
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Ryoichi Ban
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Satoru Ogawa
- Department of Pediatrics, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Kyoko Sakai
- Department of Laboratory Medicine, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Kimitaka Takitani
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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18
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Indrio F, Marchese F, Rinaldi M, Maffei G, Dargenio V, Cinquepalmi R, Mantovani MP, Aceti A. Is acidemia at birth a risk factor for functional gastrointestinal disorders? Eur J Pediatr 2022; 181:3625-3633. [PMID: 35927380 PMCID: PMC9508039 DOI: 10.1007/s00431-022-04565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Functional gastrointestinal disorders (FGIDs) are common in early childhood. It has been demonstrated that neonatal acidemia at delivery can lead to significant neonatal morbidity. The primary aim of this study was to evaluate the relationship between acidemia at birth and the development of FGIDs, as regurgitation, colic, and constipation, in term infants. Term newborns born at the Foggia University Hospital, Italy during the year 2020 were included in the study. As per routine clinical practice, a cord blood gas analysis on a blood sample drawn from the umbilical artery (UA) of each infant immediately after birth was performed, and Apgar score was recorded. One year after birth, each infant's parents were interviewed through a phone call to investigate development of FGIDs, feeding practices, and morbidities. During the study period, 1574 term newborns met the inclusion criteria. The prevalence of infantile colic, regurgitation, and constipation was higher in infants with low UA pH (colic 51.5% vs. 25.4%, p < 0.001; regurgitation 30.6% vs. 15.2%, p < 0.001; constipation 24.6% vs. 16.0%, p = 0.015), with infants having moderate-severe acidemia facing the highest risk for all the examined FGIDs. In binary logistic regression analyses, UA pH and perinatal antibiotic exposure proved to be independently associated with the later diagnosis of each FGID. CONCLUSION Newborns with acidemia at birth appear to face a higher risk of FGIDs in infancy. Avoiding low cord blood pH should continue to be the goal for obstetricians, while enhanced long-term surveillance for infants who experienced birth acidemia should be required. WHAT IS KNOWN • Cord blood gas analysis is recommended in all high-risk deliveries, and in some centers, it is performed after all deliveries. • Neonatal acidemia at birth has been linked to adverse outcomes, mainly neurological. Recently, perinatal asphyxia has been reported to increase the risk of developing necrotizing enterocolitis in term infants. WHAT IS NEW • An association between acidemia at birth and risk of developing FGIDs such as regurgitation and colic during the first year of life had never been described so far. • An increased surveillance of infants with low UA pH at birth may be beneficial and could allow for early detection of any of the reported FGIDs.
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Affiliation(s)
- Flavia Indrio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy.
| | - Flavia Marchese
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Matteo Rinaldi
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Gianfranco Maffei
- Department of Neonatology and NICU, Ospedali Riuniti Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Vanessa Dargenio
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Roberta Cinquepalmi
- Department of Medical and Surgical Science, Pediatric Section, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Massimo Pettoello Mantovani
- European Pediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany ,Association Pour L’Activité Et La Recherche Scìentifiques, Nouchatel, Switzerland ,University of Foggia, Foggia, Italy ,Italian Society of Pediatrics, Rome, Italy ,Italian Academy of Pediatrics, Milan, Italy
| | - Arianna Aceti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy ,Neonatal Intensive Care Unit, IRCCS AOUBO, Via Massarenti 9, 40138 Bologna, Italy
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19
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Niemuth M, Küster H, Simma B, Rozycki H, Rüdiger M, Solevåg AL. A critical appraisal of tools for delivery room assessment of the newborn infant. Pediatr Res 2021:10.1038/s41390-021-01896-7. [PMID: 34969993 DOI: 10.1038/s41390-021-01896-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
Assessment of an infant's condition in the delivery room represents a prerequisite to adequately initiate medical support. In her seminal paper, Virginia Apgar described five parameters to be used for such an assessment. However, since that time maternal and neonatal care has changed; interventions were improved and infants are even more premature. Nevertheless, the Apgar score is assigned to infants worldwide but there are concerns about low interobserver reliability, especially in preterm infants. Also, resuscitative interventions may preclude the interpretation of the score, which is of concern when used as an outcome parameter in delivery room intervention studies. Within the context of these changes, we performed a critical appraisal on how to assess postnatal condition of the newborn including the clinical parameters of the Apgar score, as well as selected additional parameters and a proposed new scoring system. The development of a new scoring system that guide clinicians in assessing infants and help to decide how to support postnatal adaptation is discussed. IMPACT: This critical paper discusses the reliability of the Apgar score, as well as additional parameters, in order to improve assessment of a newborn's postnatal condition. A revised neonatal scoring system should account for infant maturity and the interventions administered. Delivery room assessment should be directed toward determining how much medical support is needed and how the infant responds to these interventions.
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Affiliation(s)
- Mara Niemuth
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Helmut Küster
- Clinic for Pediatric Cardiology, Intensive Care and Neonatology, University Medical Center Göttingen, Göttingen, Germany
| | - Burkhard Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Henry Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anne Lee Solevåg
- The Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
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Osredkar D, Verdenik I, Gergeli AT, Gersak K, Lucovnik M. Apgar Score and Risk of Cerebral Palsy in Preterm Infants: A Population-Based Cohort Study. Neuropediatrics 2021; 52:310-315. [PMID: 34162009 DOI: 10.1055/s-0041-1729181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A low Apgar score is associated with increased risk of cerebral palsy (CP) in term infants, while such association remains controversial in preterm neonates. The objective of this study was to assess association between 5-minute Apgar scores and CP in different subcategories of preterm birth based on gestational age. The Slovenian National Perinatal Information System was used to identify singleton children without congenital malformations live-born at 22 to 37 weeks of gestation between 2002 and 2010. Data were linked to the Slovenian Registry of Cerebral Palsy in children born between 2002 and 2010. CP was diagnosed at a minimum of 5 years of age. Of 11,924 children included, 241 (2.0%) died before discharge and 153 (1.3%) were diagnosed with CP. Five-minute Apgar scores <7 were significantly associated with higher risk of death or CP (compared with scores ≥9) at all preterm gestations. CP alone was associated with Apgar scores <7 only at moderately or late preterm gestation (32-36 weeks) (adjusted relative risk [aRR]: 8.27; 95% confidence interval [CI]: 1.87-36.64 for scores 0-4 and aRR: 4.96; 95% CI 1.89-13.06 for scores 5-6). In conclusion, a low 5-minute Apgar score was associated with combined outcome of neonatal death or CP in all preterm births, while in surviving preterm infants at >32 weeks a low 5-minute Apgar score was associated with CP.
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Affiliation(s)
- Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Ksenija Gersak
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Lucovnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Obstetrics and Gynecology, Department of Perinatology, University Medical Center Ljubljana, Ljubljana, Slovenia
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21
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Brandt JA, Morgenstern B, Thangarajah F, GrÜttner B, Ludwig S, Eichler C, Ratiu J, Mallmann P, Ratiu D. Evaluating the Decision-to-Delivery Interval in Emergency Cesarean Sections and its Impact on Neonatal Outcome. In Vivo 2021; 34:3341-3347. [PMID: 33144441 DOI: 10.21873/invivo.12172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In Germany, performance of an emergency Cesarean section (ECS) is recommended within an interval of ≤20 min from decision to delivery (DDI). The aim of the study was to assess the duration of DDI in ECS as well as its impact on neonatal outcome. PATIENTS AND METHODS Data from 437 patients at a single, tertiary care hospital were retrospectively analysed regarding influence on the duration of DDI. Subsequently the impact of DDI on neonatal outcome and incidence of adverse neonatal outcome was analysed. RESULTS DDI of ECS performed outside core working hours was significantly prolonged (p<0.001). Shorter DDI showed a statistically worse arterial cord blood pH (p=0.001, r=0.162) and base excess (p=0.05; r=0.094). Duration of DDI had no significant impact on the incidence of adverse neonatal outcome (p=0.123). CONCLUSION Awareness of influence on DDI might contribute to expediting DDI, but duration of DDI showed no impact on the incidence of adverse neonatal outcome. Data were not adequate to suggest a recommendation for DDI time standards.
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Affiliation(s)
- Janna-Alica Brandt
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Bernd Morgenstern
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Berthold GrÜttner
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Sebastian Ludwig
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Jessika Ratiu
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Dominik Ratiu
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
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Antenatal corticosteroids for impending late preterm (34-36+6 weeks) deliveries-A systematic review and meta-analysis of RCTs. PLoS One 2021; 16:e0248774. [PMID: 33750966 PMCID: PMC7984612 DOI: 10.1371/journal.pone.0248774] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/04/2021] [Indexed: 01/24/2023] Open
Abstract
Background Administration of antenatal corticosteroids (ANC) for impending preterm delivery beyond 34 weeks of gestation continues to be a controversial issue despite various guidelines for obstetricians and gynaecologists. Objective To compare outcomes following exposure to ANC for infants born between 34–36+6 weeks’ gestation. Methods A systematic review of randomised controlled trials (RCT) reporting neonatal outcomes after ANC exposure between 34–36+6 weeks’ gestation using Cochrane methodology. Databases including PubMed, Embase, Emcare, Cochrane Central library and Google Scholar were searched in May 2020. Primary outcomes: (1) Need for respiratory support (Mechanical ventilation, CPAP, high flow) or oxygen (2) Hypoglycemia. Secondary outcomes included respiratory distress syndrome (RDS), transient tachypnoea of newborn (TTN), need for neonatal resuscitation at birth [only in the delivery room immediately after birth (not in neonatal intensive care unit (NICU)], admission to NICU, mortality and developmental follow up. Level of evidence (LOE) was summarised by GRADE guidelines. Main results Seven RCTs (N = 4144) with low to high risk of bias were included. Only one RCT was from high income countries, Meta-analysis (random-effects model) showed (1) reduced need for respiratory support [5 RCTs (N = 3844); RR = 0.68 (0.47–0.98), p = 0.04; I2 = 55%; LOE: Moderate] and (2) higher risk of neonatal hypoglycaemia [4 RCTs (N = 3604); RR = 1.61(1.38–1.87), p<0.00001; I2 = 0%; LOE: High] after ANC exposure. Neonates exposed to ANC had reduced need for resuscitation at birth. The incidence of RDS, TTN and surfactant therapy did not differ significantly. None of the included studies reported long-term developmental follow up. Conclusions Moderate quality evidence indicates that ANC exposure reduced need for respiratory support, and increased the risk of hypoglycaemia in late preterm neonates. Large definitive trials with adequate follow up for neurodevelopmental outcomes are required to assess benefits and risks of ANC in this population.
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Cerebral superb microvascular imaging in preterm neonates: in vivo evaluation of thalamic, striatal, and extrastriatal angioarchitecture. Neuroradiology 2021; 63:1103-1112. [PMID: 33471157 DOI: 10.1007/s00234-021-02634-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the potential of superb microvascular imaging (SMI) in visualizing brain microvessels in preterm neonates of different gestational ages (GA). METHODS In this retrospective, observational pilot study, 15 preterm newborns were equally divided into GA groups: extremely (GA < 28 weeks), very (28-31 weeks), and moderate to late (32-37 weeks) preterm. All patients underwent conventional transcranial ultrasounds during the first day of life following the American Institute of Ultrasound in Medicine practice guidelines. SMI was then performed; based on their SMI morphology and location, brain microvessels were classified as extrastriatal (cortical and medullary), striatal, or thalamic. Two examiners independently classified vessels as visible or invisible. To assess the association between vessel visibility and GA, binomial logistic regression analysis (separate for each microvessel group) was performed, taking visibility as a dependent variable and both examiners and GA as predictor variables. RESULTS A statistically significant difference among GA groups was found in sex (P = 0.030), birth weight (P = 0.007), and Apgar score within 1 min after birth (P = 0.024). Microvascular visibility increased with GA for superficial vessels (P < 0.05 for both cortical and medullary), while striatal and thalamic vessels were visible in all neonates irrespective of their GA. CONCLUSIONS SMI technology shows promise to assess brain microvasculature in preterm neonates, even potentially providing data on early brain development.
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Noveski Z, Mihajlović D, Nikolić T, Petrović Z. Examination of early adaptation of newborns small for gestational age. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2102025n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Children with low body weight for gestational age are five times more likely to die in the neonatal period and 4.7 times more likely to die in the first years of life compared to children born at term. The aim To analyze early adaptation to extrauterine life of low body weight for gestational age. Material and methods: Retrospective study with the observation period January-September 2018. The data were obtained by reviewing the medical histories of newborns. As parameters of early adaptation, we observed the Apgar score in the 1st and 5th minute as well as the presence of polycythemia at birth. Results: Out of a total of 405 newborns, 52 had low body weight for gestational age. Apgar score in the 1st and 5th minute was statistically significantly lower in children small for gestational age compared to children with normal body weight for gestational age (p <0.05). Polycythemia is a mechanism of adaptation statistically significantly more often present in children of small body weight for gestational age (p <0.05). Conclusion: Children of low body weight for gestational age have a lower Apgar score in the first and fifth minutes as well as more frequent polycythemia compared to children with normal body weight and we can take them as good indicators of adaptation to early extrauterine life.
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Abstract
BACKGROUND Gestational age is the major determinant of neonatal death (death within the first 28 days of life) in preterm infants. The joint effect of gestational age and Apgar score on the risk of neonatal death is unknown. METHODS Using data from the Swedish Medical Birth Register, we identified 113,300 preterm infants (22 weeks 0 days to 36 weeks 6 days of gestation) born from 1992 through 2016. In analyses stratified according to gestational age (22 to 24 weeks, 25 to 27 weeks, 28 to 31 weeks, 32 to 34 weeks, and 35 or 36 weeks), we estimated adjusted relative risks of neonatal death and absolute rate differences in neonatal mortality (i.e., the excess number of neonatal deaths per 100 births) according to the Apgar scores at 5 and 10 minutes and according to the change in the Apgar score between 5 minutes and 10 minutes. Scores range from 0 to 10, with higher scores indicating a better physical condition of the newborn. RESULTS There were 1986 neonatal deaths (1.8%). The incidence of neonatal death ranged from 0.2% (at 36 weeks of gestation) to 76.5% (at 22 weeks of gestation). Lower Apgar scores were associated with higher relative risks of neonatal death and greater absolute rate differences in neonatal mortality in all gestational-age strata. For example, among infants born at 28 to 31 weeks, the adjusted absolute rate differences according to the 5-minute Apgar score, with those who had a score of 9 or 10 serving as the reference group, were 51.7 (95% confidence interval [CI], 38.1 to 65.4) for a score of 0 or 1, 25.5 (95% CI, 18.3 to 32.8) for a score of 2 or 3, 7.1 (95% CI, 5.1 to 9.1) for a score of 4 to 6, and 1.2 (95% CI, 0.5 to 1.9) for a score of 7 or 8. An increase in the Apgar score between 5 minutes and 10 minutes was associated with lower neonatal mortality than a stable Apgar score. CONCLUSIONS In this study, Apgar scores at 5 and 10 minutes provided prognostic information about neonatal survival among preterm infants across gestational-age strata. (Funded by the Swedish Research Council for Health, Working Life, and Welfare and Karolinska Institutet.).
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Affiliation(s)
- Sven Cnattingius
- From the Division of Clinical Epidemiology, Department of Medicine Solna (S.C., S.J., N.R.), and the Department of Clinical Science and Education (S.J.), Karolinska Institutet, Stockholm
| | - Stefan Johansson
- From the Division of Clinical Epidemiology, Department of Medicine Solna (S.C., S.J., N.R.), and the Department of Clinical Science and Education (S.J.), Karolinska Institutet, Stockholm
| | - Neda Razaz
- From the Division of Clinical Epidemiology, Department of Medicine Solna (S.C., S.J., N.R.), and the Department of Clinical Science and Education (S.J.), Karolinska Institutet, Stockholm
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De Bernardo G, De Santis R, Giordano M, Sordino D, Buonocore G, Perrone S. Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score. Ital J Pediatr 2020; 46:20. [PMID: 32050997 PMCID: PMC7017611 DOI: 10.1186/s13052-020-0786-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/06/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. The umbilical blood gas analysis is a valid tool for the evaluation of neonatal acidaemia. However, umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores < 7 at 5 min. METHODS A retrospective cohort study was conducted from June to December 2018 at the Department of mother's and child's health, Poliambulanza Foundation Hospital Institute. Inclusion criteria were: full term newborns with body weight appropriate for gestational age, born by vaginal delivery or caesarean section, reassuring Apgar Score > 7 at 5 min, arterial cord blood gas analysis showing pH < 7.4 or BE <-8 mmol/l or lactate > 6 mmol/l. The aim was to evaluate the predictive role of blood gas analysis for respiratory distress syndrome in newborns with reassuring Apgar Score. RESULTS 352 full term newborns were enrolled. Umbilical cord blood artery pH showed an association with respiratory distress syndrome (χ2(1) = 10,084, OR (95% CI): 3,9 × 10- 4(2,9 × 10- 6 - 0,048); p < 0,05). ROC curve revealed that the cut-off point of pH was 7.12, with a sensibility and specificity of 68 and 63%, respectively. CONCLUSIONS Umbilical cord blood artery pH < 7.12 at birth is associated to respiratory distress syndrome in newborns. Blood gas analysis is an important instrument to help health care providers during assistance in the delivery room, but also to early identify newborns at high risk for respiratory distress syndrome and better manage the care of these newborns after birth.
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Affiliation(s)
- Giuseppe De Bernardo
- Department of Pediatrics, Neonatology and Neonatal Intensive Care Unit, Buon Consiglio Fatebenefratelli Hospital, Via Manzoni 220, 80123 Napoli, Campania Italy
| | - Rita De Santis
- School of specialization in Pediatrics, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | | | - Desiree Sordino
- Department of Emergency, NICU A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Serafina Perrone
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Blundell PDM, Chakraborty M. Relationship between Apgar Scores and Morbidity and Mortality Outcomes in Preterm Infants: A Single-Centre Cohort Study. Neonatology 2020; 117:742-749. [PMID: 33429398 DOI: 10.1159/000512524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Apgar scoring in modern practice has extended beyond the original described remit by Virginia Apgar, including prognostication. Prognostic value of Apgar scoring in preterm populations is unsupported by robust evidence. OBJECTIVES We aimed to identify the association between mortality or a composite mortality/major morbidity outcome in preterm infants with 1-min, 5-min, and sum 1 + 5-min Apgar scores. METHODS Seven-year retrospective data was analysed on neonates born <32 weeks gestation in a regional neonatal centre. Co-primary outcomes were mortality and composite mortality/major morbidity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression analysis. RESULTS 394 infants were included in the analysis. In neonates born <28 weeks gestation, no significant association was found between Apgar scores and the co-primary outcomes. In neonates born ≥28 weeks, low 1-min (aOR 10.452 [1.273, 85.835] for scores 4-6, 22.173 [2.666, 184.438] for scores 0-3), 5-min (4.724 [1.616, 13.806] for scores 4-6, 11.178 [1.803, 69.299] for scores 0-3), and sum 1 + 5-min Apgar scores (12.447 [2.674, 57.941] for scores 4-6, 55.960 [8.333, 375.804] for scores 0-3) were associated with significantly increased aOR of mortality. Increased aOR of composite mortality/major morbidity were also seen in neonates with moderately low (4-6) Apgar scores (aOR 3.104 [1.522, 6.328] for 1 min, 2.804 [1.406, 5.594] for 5 min, and 3.232 [1.769, 5.905] for 1 + 5 min). CONCLUSIONS Apgar scoring at 1 and 5 min has limited prognostic accuracy for extremely preterm infants but is prognostic in older infants. Sum Apgar scores, a measure of initial condition and response to resuscitation, may be a better predictor of mortality than individual scores.
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Affiliation(s)
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, United Kingdom, .,Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom,
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Ullah MB, Mridha MK, Arnold CD, Matias SL, Khan MSA, Siddiqui Z, Hossain M, Paul RR, Dewey KG. Newborn physical condition and breastfeeding behaviours: Secondary outcomes of a cluster-randomized trial of prenatal lipid-based nutrient supplements in Bangladesh. MATERNAL & CHILD NUTRITION 2019; 15:e12844. [PMID: 31106491 PMCID: PMC6859973 DOI: 10.1111/mcn.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/19/2019] [Accepted: 05/10/2019] [Indexed: 01/13/2023]
Abstract
Prenatal nutritional supplements may improve birth outcomes. This study aims to examine the effect of prenatal lipid-based nutrient supplements (LNS), compared with iron and folic acid (IFA), on general newborn physical condition and feeding behaviours. We conducted a cluster-randomized effectiveness trial that enrolled 4,011 pregnant women at ≤20 gestational weeks. LNS and IFA were provided to women in 48 and 16 clusters, respectively, for daily consumption until delivery. We collected data on household socio-economic, food insecurity, and maternal characteristics during early pregnancy and on newborn condition and feeding within 72 hr of delivery. We analysed intervention effects on these secondary outcomes using mixed models with analysis of covariance for continuous outcomes and logistic regression for dichotomous outcomes. Among 3,664 live births, intervention groups did not differ in newborn response, mother's rating of the general condition of her newborn, early initiation of breastfeeding (EIBF), suckling ability, or frequency and exclusivity of breastfeeding in the first 24 hr. If the mother perceived her infant to be healthy, EIBF was more likely (OR [95% CI]: 2.08 [1.46, 2.97]) and frequency of breastfeeding in the first 24 hr was greater (mean difference [95% CI]: 3.0 [1.91, 4.01]), but there was no difference in exclusive breastfeeding in the first 24 hr. Newborn condition and early breastfeeding practices were not affected by giving mothers prenatal LNS versus IFA. However, early breastfeeding practices were related to maternal perception of her newborn's condition. Thus, interventions to improve breastfeeding practices for newborns with poorer perceived health status may be useful.
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Affiliation(s)
- Md Barkat Ullah
- Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Malay K. Mridha
- Center for Non‐communicable Disease and Nutrition, James P. Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | | | - Susana L. Matias
- Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Md Showkat A. Khan
- Center for Non‐communicable Disease and Nutrition, James P. Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Zakia Siddiqui
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
| | - Mokbul Hossain
- Center for Non‐communicable Disease and Nutrition, James P. Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | | | - Kathryn G. Dewey
- Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
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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.
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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
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30
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Del Riesgo-Prendes L, Salamanca-Matta AL, Monterrey-Gutiérrez PA, Bermúdez-Hernández PA, Vélez JL, Suárez-Rodríguez G. [Perinatal hypoxia at Hospital Mederi in Bogotá: behavior in the period 2007-2011]. ACTA ACUST UNITED AC 2019; 19:332-339. [PMID: 30183937 DOI: 10.15446/rsap.v19n3.65204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 04/02/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify maternal, fetal and neonatal risk factors associated with perinatal hypoxia in neonates at Hospital Universitario Mayor Mederi (HUM Mederi) from 2007 to 2011. METHODOLOGY In the period 2007-2011, 8 837 children were born in HUM Mederi. Only the cases that presented with perinatal asphyxia (PA), according to the American Congress of Obstetricians and Gynecologists (ACOG), or another respiratory distress (RD) diagnosis were considered for this analysis, based on the computer records of the Neonatology Service in HUM Mederi. Maternal, fetal and neonatal risk factors were analyzed. Data were shown according to the number of newborns in each group and their percentage. RESULTS The overall mortality rate was 10.7. The lowest values were found in 2010 and 2011 (3.3 and 1.8, respectively). Gestational diabetes, hypertension, chorioamnionitis and placenta previa were more frequent in the RD group, whereas hypoglycemia, sepsis, hypotonia and hypoactivity among neurological alterations were more common in the PA group. Correspondence between neurological alterations and Apgar Test was low in the cases diagnosed with PA. CONCLUSIONS The mortality rate was very low compared to regional and local levels, and more infants presented with moderate perinatal asphyxia. These results coincide with literature reports. The high number of preterm births with DR emphasizes the importance of controlling the implementation of actions to reduce the risk factors associated with this condition.
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Affiliation(s)
| | | | | | | | - Juan L Vélez
- J.V.: MD. Hospital Juan Pablo Tobón Uribe. Medellín, Colombia.
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Witcher TJ, Jurdi S, Kumar V, Gupta A, Moores RR, Khoury J, Rozycki HJ. Neonatal Resuscitation and Adaptation Score vs Apgar: newborn assessment and predictive ability. J Perinatol 2018; 38:1476-1482. [PMID: 30093618 DOI: 10.1038/s41372-018-0189-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the non-inferiority of an alternative to the Apgar score. STUDY DESIGN The Neonatal Resuscitation and Adaptation Score (NRAS) was recorded in parallel to the Apgar score by a resuscitation team at deliveries. Correlation between the systems was assessed, as well as the predictive ability of NRAS and Apgar scores for mortality or short-term morbidities. RESULTS A total of 340 infants were in the study group. The two scores correlated strongly (r = 0.87 and 0.83 at 1 and 5 min, respectively). Those needing ventilation at 48 h of life had a 5-min NRAS < 7 in 23/26 vs Apgar < 7 (23/36, p = 0.001). A low (0-3) 1-min NRAS score was more predictive of death, 53% vs 17%, p = 0.0065. CONCLUSIONS NRAS correlates with Apgar status assessment, and identifies newborns who die or may require further care better than the Apgar score.
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Affiliation(s)
- Teresa J Witcher
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Shadi Jurdi
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Vidhya Kumar
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Aditi Gupta
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Russell R Moores
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Joseph Khoury
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Henry J Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
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Yeagle KP, O'Brien JM, Curtin WM, Ural SH. Are gestational and type II diabetes mellitus associated with the Apgar scores of full-term neonates? Int J Womens Health 2018; 10:603-607. [PMID: 30323688 PMCID: PMC6181089 DOI: 10.2147/ijwh.s170090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare Apgar scores of full-term newborns of mothers with gestational (GDM) or type II diabetes mellitus (T2DM) with scores of newborns of mothers without impaired glucose tolerance. Study design This was a retrospective data collection study (n=297). We reviewed 1-minute and 5-minute neonatal Apgar scores of newborns of mothers with GDM (n=100) or T2DM (n=97). Our control group consisted of newborns of mothers without a prior history of impaired glucose tolerance (n=100). ANOVA and linear model with corrected errors were used and adjusted for newborn sex and weight, and maternal age. Chi-squared analysis was performed for newborn sex. Results The mean 1-minute and 5-minute Apgar scores were 7.8 and 8.9 for the GDM group and 7.7 and 8.9 for the T2DM group, respectively. There was no statistical difference in the 1-minute and 5-minute Apgar scores between the GDM group and controls (P=0.89 and P=0.13, respectively) nor in the scores between the T2DM group and controls (P=0.67 and P=0.40, respectively). Conclusion Maternal history of GDM and T2DM does not appear to be associated with the 1-minute and 5-minute Apgar scores of full-term newborns of mothers with GDM and T2DM as compared to newborns of mothers without a history of impaired glucose tolerance.
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Affiliation(s)
- Kevin P Yeagle
- Penn State Hershey, Department of the College of Medicine, Hershey, PA, USA,
| | - James Michael O'Brien
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
| | - William M Curtin
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
| | - Serdar H Ural
- Penn State Hershey Obstetrics and Gynecology, Department of Maternal Fetal Medicine, Hershey, PA, USA
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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.
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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
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Matsuda N, Taki A, Tsuji A, Nakajima K, Takasawa K, Morioka C, Minosaki Y, Oku K, Kashimada K, Morio T. Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age. Clin Pediatr Endocrinol 2018; 27:31-38. [PMID: 29403154 PMCID: PMC5792819 DOI: 10.1297/cpe.27.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022] Open
Abstract
Factors affecting growth and development in extremely low birth weight infants (ELBWIs)
born small for gestational age (SGA) have not been precisely elucidated. We performed a
retrospective analysis of ELBWIs born SGA who were treated in the neonatal intensive care
unit of Kawaguchi Municipal Medical Centre, Japan. A total 244 ELBWIs were born from 2003
to 2010, and 31 were born with weight and height below the 10th percentile for their
gestational age. Among the 31 ELBWIs born SGA, we excluded 9 who died before they reached
3 yr of age or who had severe developmental retardation. A total of 16 patients (weight,
510–998 g; GA, 28w0d–32w5d) who were followed until age 3 yr were eligible for our study.
At age 3 yr, 94% and 88% of ELBWIs were above the −2 standard deviation (SD) for height
and weight, respectively. A history of mechanical ventilation was associated with height.
The average score of the full developmental quotient (DQ) was 85, and 63% (10/16) of
ELBWIs scored more than 85. Lower Apgar score (≤ 7) was a risk factor for lower DQ scores
in motor development and full development. Our study revealed that most ELBWIs born SGA
were more than −2 SD below the mean for height and body weight.
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Affiliation(s)
- Nozomi Matsuda
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsuko Taki
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Atsumi Tsuji
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Keisuke Nakajima
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Chikako Morioka
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Yoshihiro Minosaki
- Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Kikuko Oku
- Neonatal Intensive Care Unit (NICU), Kawaguchi Municipal Medical Center, Saitama, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Cnattingius S, Norman M, Granath F, Petersson G, Stephansson O, Frisell T. Apgar Score Components at 5 Minutes: Risks and Prediction of Neonatal Mortality. Paediatr Perinat Epidemiol 2017; 31:328-337. [PMID: 28493508 DOI: 10.1111/ppe.12360] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Apgar score consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and colour. Although the Apgar score has been used for 60 years, the specific contribution of the Apgar score components with respect to risks and prediction of neonatal mortality remains unknown. Likewise, the value of reduced scores (including less than five Apgar score components) has rarely been investigated. METHODS In a population-based cohort study of 148 765 liveborn singleton infants in Sweden 2008-2013, we investigated components of Apgar score at 5 min with respect to relative risks and prediction (using ROC curves, sensitivity, and positive predictive values) of neonatal mortality. RESULTS Reduced values (0-1) of heart rate, respiratory effort, and colour were independently associated with increased relative risks of neonatal mortality. For the full Apgar score, the sensitivity and positive predictive values of neonatal mortality (cut-off ≤3) were by gestational age: ≤31 weeks: 56.1% and 49.2%; 32-36 weeks: 25.0% and 18.2%; and ≥37 weeks: 35.2% and 9.3%, respectively. When only heart rate and respiratory effort were considered (range 0-4; cut-off ≤2), corresponding values were 66.7% and 34.9%; 37.5% and 13.0%; and 46.3% and 7.6%, respectively. CONCLUSIONS A reduced Apgar score has generally the same predictability of neonatal mortality as the full Apgar score. The full Apgar score or reduced scores may be better predictors of neonatal mortality in very preterm infants (≤31 weeks) than in infants with longer gestations.
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Affiliation(s)
- Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Petersson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Epidemiology, School of Public Health, University of California, Berkeley, CA
| | - Thomas Frisell
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Kim SH, Choi BY, Park J, Jung EY, Cho SH, Park KH. Maternal and Placental Factors Associated with Congenital Hearing Loss in Very Preterm Neonates. Pediatr Neonatol 2017; 58:236-244. [PMID: 27596679 DOI: 10.1016/j.pedneo.2016.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/21/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Sensorineural hearing loss (SNHL) is a multifactorial disease that more frequently affects preterm newborns. Although a number of maternal conditions have been reported to be associated with preterm birth, little information is available concerning maternal risk factors for the development of SNHL. We aimed to identify maternal and placental risk factors associated with a "refer" result on the newborn hearing screening (NHS) test and subsequently confirmed SNHL in very preterm neonates. METHODS This retrospective cohort study included 267 singleton neonates who were born alive after ≤ 32 weeks. Histopathologic examination of the placenta was performed, and clinical data were retrieved from a computerized perinatal database. Cases with two abnormal findings, "refer" on the NHS test, and presence of SNHL on the confirmation test were retrospectively reviewed based on electronic medical records. RESULTS Forty-two neonates (15.7%) showed a "refer" result, and, on the confirmation test, permanent SNHL was identified in 1.87% (5/267) of all neonates. Multivariate regression analysis revealed that the presence of funisitis was independently associated with a "refer" on the NHS test, whereas use of antenatal corticosteroids was statistically significantly associated with a reduced incidence of "refer" on the screening test. Neither histologic chorioamnionitis nor prematurity (as defined by low gestational age and birth weight) was associated with a "refer" on the NHS test. By contrast, multivariate analysis with occurrence of SNHL as a dependent variable identified no significant associations with the parameters studied, probably owing to the small total number of neonates with permanent SNHL. CONCLUSION Presence of funisitis was significantly and independently associated with increased risk of abnormal NHS results, while administration of antenatal corticosteroids was related to a normal NHS result. These findings support the hypothesis that a systemic fetal inflammatory response, manifested as funisitis, might play a role in the pathogenesis of SNHL in preterm neonates.
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Affiliation(s)
- Shin Hye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jaehong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Young Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Soo-Hyun Cho
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Thavarajah H, Flatley C, Kumar S. The relationship between the five minute Apgar score, mode of birth and neonatal outcomes. J Matern Fetal Neonatal Med 2017; 31:1335-1341. [DOI: 10.1080/14767058.2017.1315666] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, South Brisbane, Australia
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, South Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Lai S, Flatley C, Kumar S. Perinatal risk factors for low and moderate five-minute Apgar scores at term. Eur J Obstet Gynecol Reprod Biol 2017; 210:251-256. [PMID: 28076828 DOI: 10.1016/j.ejogrb.2017.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/23/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the specific maternal and perinatal variables associated with a low (≤3) or moderate (4-6) Apgar score, compared to a high (≥7) score. STUDY DESIGN This was a retrospective, cohort study of 58429 term singleton babies born at the Mater Mother's Hospital in Brisbane, Australia in 2007-2013. Maternal demographics, socio-economic status using the Australian Socioeconomic Index for Areas (SEIFA) score, obstetric factors, and birth outcomes were compared for neonates grouped into three categories based on their five-minute Apgar: low (≤3), moderate (4-6) and high (≥7). The low- and moderate-score cohorts were individually compared to the high-score cohort using both univariate and multivariate analysis. RESULTS Logistic regression analysis confirmed that of the variables analysed, only maternal public insurance status (OR 2.1, 95% CI 1.5-3.1), breech presentation (OR 2.4, 95% CI 1.1-4.6), other non-cephalic presentation (OR 9.5, 95% CI 2.2-25.4), intramuscular narcotic use (OR 2.3, 95% CI 1.5-3.5), and presence of meconium (OR 3.7, 95% CI 2.5-5.4) were significantly associated with low Apgar scores. Variables significantly associated with a moderate score were: SEIFA ≤50th centile (OR 1.6, 95% CI 1.2-2.0) and 61st to 70th centile (OR 1.31, 95% CI 0.9-1.8) categories, maternal public insurance status (OR 2.7, 95% CI 2.2-3.3), nulliparity (OR 2.0, 95% CI 1.7-2.5), emergency caesarean birth (OR 2.6, 95% CI 2.1-3.2), instrumental birth (OR 2.3, 95% CI 1.9-2.9), and presence of meconium (OR 2.6, 95% CI 2.1-3.2). CONCLUSIONS Factors associated with low and moderate Apgar scores vary in type and degree of influence. Distinctions in the perinatal background can help predict newborn compromise and accelerate delivery of care.
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Affiliation(s)
- Shimona Lai
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Christopher Flatley
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia
| | - Sailesh Kumar
- Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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Haines M, Wright IM, Bajuk B, Abdel-Latif ME, Hilder L, Challis D, Guaran R, Oei JL. Population-based study shows that resuscitating apparently stillborn extremely preterm babies is associated with poor outcomes. Acta Paediatr 2016; 105:1305-1311. [PMID: 27334852 DOI: 10.1111/apa.13503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/27/2022]
Abstract
AIM This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0. METHODS We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011. RESULTS We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0-2) to 45 (0-104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived. CONCLUSION Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.
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Affiliation(s)
- Morgan Haines
- School of Women's and Children's Health; University of New South Wales; Randwick NSW Australia
| | - Ian M. Wright
- Illawarra Health and Medical Research Institute and Graduate School of Medicine; The University of Wollongong; Wollongong NSW Australia
- Department of Paediatrics; The Wollongong Hospital; Wollongong NSW Australia
| | - Barbara Bajuk
- New South Wales Pregnancy and Newborn Services Network; Westmead NSW Australia
| | - Mohamed E. Abdel-Latif
- Department of Neonatology; The Canberra Hospital; Garran ACT Australia
- Faculty of Medicine; The Australian National University; Deakin ACT Australia
| | - Lisa Hilder
- School of Women's and Children's Health; University of New South Wales; Randwick NSW Australia
| | - Daniel Challis
- New South Wales Pregnancy and Newborn Services Network; Westmead NSW Australia
| | - Robert Guaran
- New South Wales Pregnancy and Newborn Services Network; Westmead NSW Australia
| | - Ju Lee Oei
- School of Women's and Children's Health; University of New South Wales; Randwick NSW Australia
- Department of Newborn Care; Royal Hospital for Women; Randwick NSW Australia
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40
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Kullinger M, Haglund B, Kieler H, Skalkidou A. Effects of ultrasound pregnancy dating on neonatal morbidity in late preterm and early term male infants: a register-based cohort study. BMC Pregnancy Childbirth 2016; 16:335. [PMID: 27799069 PMCID: PMC5088647 DOI: 10.1186/s12884-016-1129-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/25/2016] [Indexed: 12/02/2022] Open
Abstract
Background Assessing gestational age by ultrasound can introduce a systematic bias due to sex differences in early growth. Methods This cohort study included data on 1,314,602 births recorded in the Swedish Medical Birth Register. We compared rates of prematurity-related adverse outcomes in male infants born early term (gestational week 37–38) or late preterm (gestational week 35–36), in relation to female infants, between a time period when pregnancy dating was based on the last menstrual period (1973–1978), and a time period when ultrasound was used for pregnancy dating (1995–2010), in order to assess the method’s influence on outcome by fetal sex. Results As expected, adverse outcomes were lower in the later time period, but the reduction in prematurity-related morbidity was less marked for male than for female infants. After changing the pregnancy dating method, male infants born early term had, in relation to female infants, higher odds for pneumothorax (Cohort ratio [CR] 2.05; 95 % confidence interval [CI] 1.33–3.16), respiratory distress syndrome of the newborn (CR 1.99; 95 % CI 1.33–2.98), low Apgar score (CR 1.26; 5 % CI 1.08–1.47), and hyperbilirubinemia (CR 1.12; 95 % CI 1.06–1.19), when outcome was compared between the two time periods. A similar trend was seen for late preterm male infants. Conclusion Misclassification of gestational age by ultrasound, due to size differences, can partially explain currently reported sex differences in early term and late preterm infants’ adverse neonatal outcomes, and should be taken into account in clinical decisions and when interpreting study results related to fetal sex. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1129-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Merit Kullinger
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden. .,Department of Obstetrics and Gynecology, Västmanland County Hospital, Västerås, Sweden.
| | - Bengt Haglund
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Helle Kieler
- Department of Medicine, Solna, Centre for Pharmacoepidemiology (CPE), Karolinska Institute, Stockholm, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Abstract
Birth asphyxia, also termed perinatal hypoxia-ischemia, is a modifiable condition as evidenced by improved outcomes of infants ≥36 weeks' gestation provided hypothermia treatment in randomized trials. Preterm animal models of asphyxia in utero demonstrate that hypothermia can provide short-term neuroprotection for the developing brain, supporting the interest in extending therapeutic hypothermia to preterm infants. This review focuses on the challenge of identifying preterm infants with perinatal asphyxia; the neuropathology of hypoxic-ischemic brain injury across extreme, moderate, and late preterm infants; and patterns of brain injury, use of therapeutic hypothermia, and approach to patient selection for neuroprotective treatments among preterm infants.
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Affiliation(s)
- Abbot R Laptook
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02905, USA.
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Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study. PLoS Med 2016; 13:e1002033. [PMID: 27270217 PMCID: PMC4896455 DOI: 10.1371/journal.pmed.1002033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Maternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI]) over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term. METHODS AND FINDINGS This study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk) infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012. We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0-6) at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs) were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (<25 versus ≥25 kg/m2) in the first pregnancy. Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of -1 to <1 kg/m2), the adjusted OR for a low Apgar score in the offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12-1.58). The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00-2.02) and 1.78 (95% CI 1.19-2.68), respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI < 25 kg/m2 in the first pregnancy. A study limitation was the lack of data on the effects of obstetric interventions and neonatal resuscitation efforts. CONCLUSIONS Risks of birth-asphyxia-related outcomes increased with maternal weight gain between pregnancies. Preventing weight gain before and in between pregnancies may improve neonatal health.
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Oliveira LLD, Gonçalves ADC, Costa JSDD, Bonilha ALDL. Maternal and neonatal factors related to prematurity. Rev Esc Enferm USP 2016; 50:382-9. [DOI: 10.1590/s0080-623420160000400002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
ABSTRACT OBJECTIVE To identify maternal and neonatal factors associated with prematurity in the municipality of Porto Alegre. METHOD This was a population-based case-control study. The cases were newborns under 37 weeks of gestation and the controls were newborns over 37 weeks. The data came from the records of 19,457 births in the city of Porto Alegre in the year 2012 from the Information System on Live Births of the Municipal Health Department. The analysis was carried outand adjusted by a Logistic Regression according to a hierarchical model. The variables studied were allocated into three hierarchy levels: sociodemographic variables; reproductive history; and gestational and birth factors. RESULTS There were 767 cases allocated and 1,534 controls in a design of a case for two controls (1:2) by simple randomization. In the final model, a statistically significant association was found for prematurity for the following variables: mother's age under 19 years old (OR=1.32; CI 95%: 1.02-1.71) or over 34 years old (OR=1.39; CI 95%: 1.12-1.72); inadequate maternal schooling for age (OR=2.11; CI 95%: 1.22-3.65); multiple pregnancies (OR=1.14; CI 95%: 1.01-1.29); C-section (OR=1.15; CI 95%: 1.03-1.29); birth weights under 2,500g (OR=4.04; CI 95%: 3.64-4.49); Apgar score at five minutes between zero and three (OR=1.47; CI 95%: 1.12-1.91); and inadequate prenatal care (OR=1.18; CI 95%: 1.02-1.36). CONCLUSION The present study showed the most immediate consequence of prematurity for newborns by evidencing its association with worse Apgar scores and low birth weight. The following factors were also shown as possible more distal determinants of prematurity: mother's age; inadequate maternal education; multiple gestation; inadequate prenatal care; and C-section.
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Grizenko N, Eberle ML, Fortier ME, Côté-Corriveau G, Jolicoeur C, Joober R. Apgar Scores Are Associated with Attention-Deficit/Hyperactivity Disorder Symptom Severity. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:283-90. [PMID: 27254803 PMCID: PMC4841284 DOI: 10.1177/0706743716635544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Adverse events during pregnancy and delivery have been linked to attention-deficit/hyperactivity disorder (ADHD). Previous studies have investigated Apgar scores, which assess the physical condition of newborns, in relation to the risk of developing ADHD. We propose to go one step further and examine if Apgar scores are associated with ADHD symptom severity in children already diagnosed with ADHD. METHOD ADHD symptoms severity, while off medication, was compared in 2 groups of children with ADHD: those with low (≤6, n = 52) and those with higher (≥7, n = 400) Apgar scores sequentially recruited from the ADHD clinic. RESULTS Children with low Apgar at 1 minute after birth had more severe symptoms as assessed by the externalizing scale of the Child Behaviour Checklist, the Conners' Global Index for Parents, and the DSM-IV hyperactivity symptoms count (P = 0.02, <0.01, <0.01, respectively). CONCLUSION Low 1-minute Apgar scores are associated with a significant increase in ADHD symptom severity. These findings underline the importance of appropriate pregnancy and perinatal care.
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Affiliation(s)
- Natalie Grizenko
- Department of Psychiatry, McGill University, Montreal, Quebec Child and Adolescent Psychiatry Program, Douglas Mental Health University Institute, Montreal, Quebec
| | | | | | | | - Claude Jolicoeur
- Department of Psychiatry, McGill University, Montreal, Quebec Child and Adolescent Psychiatry Program, Douglas Mental Health University Institute, Montreal, Quebec
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Quebec Douglas Mental Health University Institute, Montreal, Quebec
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Eun S, Lee JM, Yi DY, Lee NM, Kim H, Yun SW, Lim I, Choi ES, Chae SA. Assessment of the association between Apgar scores and seizures in infants less than 1 year old. Seizure 2016; 37:48-54. [PMID: 26987036 DOI: 10.1016/j.seizure.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The study aimed to assess the association between Apgar scores at 1 and 5 min after birth and seizures in infants less than 1 year old. METHODS We conducted a retrospective, observational, hospital-based study by utilising medical records from the Chung-Ang University Hospital admissions from January 2006 to May 2015 in order to identify infants less than 1 year old who had a history of seizures. Using electronic medical records, infants who were diagnosed with infantile seizures at the Chung-Ang University Hospital from January 2006 to May 2015 were included in the seizure group (n=93), and a control group consisting of 296 age-matched cases without a history of seizures was selected from a group of infants born at Chung-Ang University Hospital during the same study period. RESULTS We found that Apgar scores were significant risk factors for infantile seizures. Apgar scores differed depending on gestational age and birth weight. We found strong associations between Apgar scores and infantile seizures in the full-term and the normal-birth weight groups (bodyweight ≥2.5 kg), regardless of delivery mode. The Apgar scores were inversely correlated with the EEG class, and only the 1-min Apgar scores were correlated with MRI findings. CONCLUSION Low Apgar scores are significant perinatal risk factors for infantile seizures, especially in full-term and normal-birth weight infants, and have a strong negative linear relationship with EEG and brain MRI results in the seizure group.
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Affiliation(s)
- Seonghoon Eun
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Jeong Min Lee
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Dae Yong Yi
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Na Mi Lee
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Hyery Kim
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Sin Weon Yun
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - InSeok Lim
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Eung Sang Choi
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea
| | - Soo Ahn Chae
- Department of Pediatrics, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong Dongjak-gu, Seoul 156-755, Republic of Korea.
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Abstract
The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
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Abstract
The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions.
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Almeida NKO, Almeida RMVR, Pedreira CE. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J) 2015; 91:493-8. [PMID: 26054772 DOI: 10.1016/j.jped.2014.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34. METHODS Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia. RESULTS For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years), and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births), of low Apgar score at 5 min (for term births), of macrosomia (for non-primiparous women), and of asphyxia. CONCLUSION As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.
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Affiliation(s)
- Núbia Karla O Almeida
- Department of Statistics, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Renan M V R Almeida
- Biomedical Engineering Program, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - Carlos Eduardo Pedreira
- Electrical Engineering Program, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Medicine Scholl, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; Programa de Engenharia de Sistemas e Computação (PESC), Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (COPPE), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Adverse perinatal outcomes for advanced maternal age: a cross‐sectional study of Brazilian births. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jurdi SR, Jayaram A, Sima AP, Hendricks Muñoz KD. Evaluation of a Comprehensive Delivery Room Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score: A Pilot Study. Glob Pediatr Health 2015; 2:2333794X15598293. [PMID: 27335974 PMCID: PMC4784623 DOI: 10.1177/2333794x15598293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study evaluated the interrater reliability and perceived importance of components of a developed neonatal adaption score, Neonatal Resuscitation Adaptation Score (NRAS), for evaluation of resuscitation need in the delivery room for extremely premature to term infants. Similar to the Apgar, the NRAS highest score was 10, but greater weight was given to respiratory and cardiovascular parameters. Evaluation of provider (N = 17) perception and scoring pattern was recorded for 5 clinical scenarios of gestational ages 23 to 40 weeks at 1 and 5 minutes and documenting NRAS and Apgar score. Providers assessed the tool twice within a 1-month interval. NRAS showed superior interrater reliability (P < .001) and respiratory component reliability (P < .001) for all gestational ages compared to the Apgar score. These findings identify an objective tool in resuscitation assessment of infants, especially those of smaller gestation age, allowing for greater discrimination of postbirth transition in the delivery room.
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Affiliation(s)
- Shadi R Jurdi
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Archana Jayaram
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Adam P Sima
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
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