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Rozycki HJ, Foglia EE, Yitayew MS, Herrick HM. Assessing newborn scoring with each resuscitation (ANSWER): Protocol for identifying and testing an Apgar score for the 21st century. PLoS One 2025; 20:e0323571. [PMID: 40373048 PMCID: PMC12080839 DOI: 10.1371/journal.pone.0323571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/09/2025] [Indexed: 05/17/2025] Open
Abstract
BACKGROUND The status of infants in the minutes after birth has been summarized by the Apgar score for the last 70 years and is applied at most medically attended deliveries around the world. It has not, however, adapted to changes in neonatal resuscitation over the decades. There are issues with application to premature newborns, how to account for the interventions outlined in the Newborn Resuscitation Program (NRP), inter-rater reliability, and local custom. Developing a modern newborn assessment score will require a series of steps, the first of which is to identify which observations or data can best differentiate a normal newborn transition from an abnormal one. METHODS Video recordings of at least 35 random normal (meeting NRP goals for heart rate and saturation without intervention, normal physical exam and requiring only normal postnatal care) and 35 random abnormal (not meeting at least 2 normal criteria) from 7 centers participating in the VERIFI study. The presence or absence of observable elements, including vital signs, appearance, and interventions will be recorded every 30 seconds for the first 5 minutes of life. Observations, as well as any changes over time or after intervention will be compared between normal and abnormal, and those that are significant and independent based on logistic regression will become candidate newborn assessment score components. EXPECTED RESULTS There are likely to be ten or more observations/elements from videos of the first five minutes of life that will differ between normal and abnormal newborns, and these will be tested in all combinations to identify the 1-3 score sets that will be applied to a new set of VERIFI videos to identify which has the best sensitivity/specificity. CONCLUSIONS Bringing newborn assessment into modern practice will build on the legacy of Dr. Apgar. A series of steps, beginning with identifying the observations/elements that best identify newborns who may need further care can lead to a universal validated tool for the 21st century.
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Affiliation(s)
- Henry J. Rozycki
- Division of Neonatal Medicine, Children’s Hospital of Richmond at VCU and Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Miheret S. Yitayew
- Division of Neonatal Medicine, Children’s Hospital of Richmond at VCU and Department of Pediatrics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Heidi M. Herrick
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Mense L, Nögel S, Kaufmann M, Küster H, Braun N, Simma B, Rüdiger M. Assessing the postnatal condition: the predictive value of single items of the Apgar score. BMC Pediatr 2025; 25:214. [PMID: 40102790 PMCID: PMC11921496 DOI: 10.1186/s12887-025-05565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/04/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND The assessment of the newborn after birth is fundamental for identifying those requiring resuscitation. Certain components of the Apgar score are used to assess neonatal condition, but their value is insufficiently validated. We aimed to identify the components of the Apgar score that predict neonatal resuscitation. METHODS Individual patient data from two multicenter trials were analyzed. Preterm newborns under 32 weeks of gestation and term newborns with perinatal acidosis and/or resuscitation were included. The extent of resuscitation was quantified by a standardized scoring system, and the clinical condition was quantified by a specified Apgar score. Correlation, linear regression and ROC analyses were used to address the study question. RESULTS A total of 2093 newborns were included. Newborns in poor clinical condition at 1 min received more interventions at 5 and 10 min. Heart rate, muscle tone, reflexes and breathing quality, but not skin color, were moderately strong correlated with the extent of resuscitation at 5 (r = 0.44 to 0.52) and 10 min (r = 0.38 to 0.42). Heart rate, reflexes and chest movement at 1 min best predicted the subsequent need for resuscitation (R2 = 0.31). The rare interventions of intubation, chest compressions and epinephrine administration can be predicted by the newborn's condition at one minute, with a high sensitivity of 84% (cutoff ≤ 4 Apgar points) or a high specificity of 86% (cutoff ≤ 7 Apgar points). CONCLUSIONS The clinical impression at 1 min can help to predict the need for medical interventions. Contrary to recent guidelines, heart rate, reflexes and chest movement seem to have the highest values. TRIAL REGISTRATION The Test APGAR study was registered at clinicaltrials.gov (NCT00623038, 14/08/2008).
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Affiliation(s)
- Lars Mense
- Division of Neonatology & Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
- Saxony Center for Feto/Neonatal Health, Technische Universität Dresden, Dresden, Germany.
| | - Sara Nögel
- Division of Neonatology & Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maxi Kaufmann
- Division of Neonatology & Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- Saxony Center for Feto/Neonatal Health, Technische Universität Dresden, Dresden, Germany
| | - Helmut Küster
- Department of Pediatric Cardiology, Intensive Care and Neonatology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Nicole Braun
- Klinikum Westbrandenburg, Campus Potsdam, Clinic of Pediatric and Adolescent Surgery, Potsdam, Germany
| | - Burkhard Simma
- Department of Pediatrics, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Mario Rüdiger
- Division of Neonatology & Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- Saxony Center for Feto/Neonatal Health, Technische Universität Dresden, Dresden, Germany
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Michel A. Evaluating the Neonate the Old-Fashioned Way. J Perinat Neonatal Nurs 2024; 38:349-350. [PMID: 39527546 DOI: 10.1097/jpn.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
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Paikaray S, Jena SK, Balakrishnan D, Mohanty PK. Correlation of cardiotocography with combined APGAR scores and diagnostic performance of umbilical cord parameters in predicting low combined APGAR scores - A prospective Cohort study. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100329. [PMID: 39184172 PMCID: PMC11342879 DOI: 10.1016/j.eurox.2024.100329] [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: 06/21/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Objectives Combined Apgar score includes utilization of interventions such as Continuous positive airway pressure, Oxygen, Mask and Bag ventilation, I ntubation and ventilation, Ne onatal chest compression, Drugs, and newborn assessment. It has been proposed as a substitute for conventional Apgar score which is the gold standard for evaluating newborns right after birth but is impacted by medical interventions and preterm. Combined Apgar scores were examined to check for correlation with CTG tracing and umbilical cord blood parameters which gives an objective assessment of fetal hypoxia, in response to the demand for a more accurate tool for evaluating the neonate and to be used for medico-legal purposes. The study's objectives were to (1) determine the association of combined Apgar scores with suspicious and pathological CTG (2) the association of umbilical cord parameters with low combined Apgar scores and the diagnostic performance of these parameters in predicting low combined Apgar scores. Study design A prospective observational cohort study was conducted in a tertiary care center in East India. 2350 consecutive laboring mothers who had completed 34 weeks of gestation underwent cardiotocography according to institutional protocol and those with suspicious and pathological CTG who delivered within 1 h of abnormal CTG were recruited. Arterial blood was analyzed and the newborn was evaluated immediately after delivery with a combined Apgar scoring system. Results Of the 2350 women, 50.7 % and 49.3 %, respectively, exhibited suspicious and abnormal CTG tracings. CTG was reported to have low diagnostic accuracy and specificity, with a sensitivity of 66.7 % and 88.9 %, respectively, in detecting combined Apgar at 1 and 5 min. The combined Apgar score at five minutes showed a strong association with acidosis. There was a statistically significant correlation between low combined Apgar and excess lactate and base at one and five minutes. With 100 % sensitivity and 95 % specificity, high lactate levels > 4.1 mM/L were found to predict newborn encephalopathy. Conclusion Umbilical cord blood parameters were found to be correlated with low combined Apgar scores. Combined Apgar scores may be a more useful tool for neonatal assessment and long-term morbidity of newborns. Additional research is required to determine whether it can take the role of conventional Apgar scores in clinical practice.
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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 2024; 96:625-631. [PMID: 34969993 DOI: 10.1038/s41390-021-01896-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Kaufmann M, Mense L, Springer L, Dekker J. Tactile stimulation in the delivery room: past, present, future. A systematic review. Pediatr Res 2024; 96:616-624. [PMID: 35124690 PMCID: PMC11499275 DOI: 10.1038/s41390-022-01945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022]
Abstract
In current resuscitation guidelines, tactile stimulation is recommended for infants with insufficient respiratory efforts after birth. No recommendations are made regarding duration, onset, and method of stimulation. Neither is mentioned how tactile stimulation should be applied in relation to the gestational age. The aim was to review the physiological mechanisms of respiratory drive after birth and to identify and structure the current evidence on tactile stimulation during neonatal resuscitation. A systematic review of available data was performed using PubMed, covering the literature up to April 2021. Two independent investigators screened the extracted references and assessed their methodological quality. Six studies were included. Tactile stimulation management, including the onset of stimulation, overall duration, and methods as well as the effect on vital parameters was analyzed and systematically presented. Tactile stimulation varies widely between, as well as within different centers and no consensus exists which stimulation method is most effective. Some evidence shows that repetitive stimulation within the first minutes of resuscitation improves oxygenation. Further studies are warranted to optimize strategies to support spontaneous breathing after birth, assessing the effect of stimulating various body parts respectively within different gestational age groups.
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Affiliation(s)
- M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany.
| | - L Mense
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany
| | - L Springer
- Division of Neonatology, Department of Paediatrics, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - J Dekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Huang S, Yitayew M, Rozycki HJ. The contribution of low Apgar scores in identifying neonates with short-term morbidities in a large single center cohort. J Perinatol 2024; 44:865-872. [PMID: 38548866 PMCID: PMC11161404 DOI: 10.1038/s41372-024-01944-0] [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: 09/07/2023] [Revised: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE To evaluate the association and utility of low 1- and 5-min Apgar scores to identify short-term morbidities in a large newborn cohort. METHODS 15,542 infants >22 weeks gestation from a single center were included. Clinical data and low Apgar scores were analyzed for significance to ten short-term outcomes and were used to construct Receiver Operating Characteristic Curves and the AUC calculated for ten outcomes. RESULTS A low Apgar score related to all (1-min) or most (5-min) outcomes by univariate and multivariate logistic regression analysis. Including any of the 4 low Apgar scores only improved the clinical factor AUC by 0.9% ± 2.7% (±SD) and was significant in just 5 of the 40 score/outcome scenarios. CONCLUSION The contribution of a low Apgar score for identifying risk of short-term morbidity does not appear to be clinically significant.
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Affiliation(s)
- Samuel Huang
- School of Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Miheret Yitayew
- School of Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, VA, USA
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Henry J Rozycki
- School of Medicine, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
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Desalegn M, Yohannes T, Tesfaye L. Determinants of low Apgar score among newborns delivered by Cesarean section in Nigist Eleni Mohammed memorial specialized hospital, Southern Ethiopia. Sci Rep 2024; 14:12420. [PMID: 38816451 PMCID: PMC11139861 DOI: 10.1038/s41598-024-62223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
A variety of factors can predispose newborns to have a low Apgar score after delivery. Identification of the determinants of low Apgar scores is an important first step to take to apply the necessary precautions. This study aimed to identify the determinants of low fifth-minute Apgar score after a Cesarean section. An institutional-based case-control study was conducted among mothers who deliver their newborns by Cesarean section in Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Ethiopia, from July 1, 2022, to September 30, 2022. Data were collected from 70 cases and 140 controls using a semi-structured checklist. A systematic random sampling technique was used to select both charts of mothers with cases and controls. Charts of mothers with newborns Apgar score less than 7 were considered as cases; whereas a similar group of charts of mothers with newborns with fifth-minute Apgar score greater than or equal to 7 were categorized as control. Descriptive statistics and bivariable and multivariable binary logistic regression analyses were conducted to describe the mothers and newborns and identify determinants of the fifth-minute low Apgar score, respectively. Adjusted odds ratios (AOR) with their respective 95% confidence interval (CI) were used to declare the determinant factors, and the statistical significance was set at P < 0.05. In total, 140 controls and 70 cases of mothers charts were enrolled in this study. The Mean ± SD age of mothers of cases and controls were 26.9 ± 4.9 and 27.06 ± 4.1 years, respectively. General anaesthesia (AOR = 4.2; 95% CI: 1.9 ‒ 9.3), rural residence (AOR = 3.7, 95% CI, 1.7‒8.1), low birth weight (AOR = 3.2, 95% CI, 1.3‒7.8), and emergency Cesarean section (AOR = 2.6; 95% CI: 1.2 ‒ 5.8) were identified determinant factors of low fifth minute Apgar score. A fifth-minute low Apgar score was significantly associated with newborns delivered through emergency Cesarean section, low birth weight, rural residence, and delivered from mothers who had undergone Cesarean section under general anaesthesia.
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Affiliation(s)
- Mitiku Desalegn
- Department of Anesthesia, College of Medicine and Health Sciences, Wachemo University, Hosaina, Ethiopia.
| | - Tadele Yohannes
- School of Public Health, College of Medicine & Health Sciences, Wachemo University, Hosaina, Ethiopia
| | - Legesse Tesfaye
- School of Public Health, College of Medicine & Health Sciences, Wachemo University, Hosaina, Ethiopia
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Liu H, Yan S, Wu F, Bai T, Zhang F. Outcomes of vertex-vertex vs. vertex-breech presentation in twin pregnancy after vaginal delivery in China. Birth 2023; 50:978-987. [PMID: 37485609 DOI: 10.1111/birt.12737] [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: 01/23/2021] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To compare the maternal and neonatal outcomes of twin pregnancies between vertex and nonvertex presentations of the second twin in vaginal delivery. METHODS In this unicentric retrospective cohort study, we collected data from 213 cases of vaginal twin deliveries from January 2016 to July 2020. Participants were divided into the vertex-vertex presentation group (VV) and vertex-breech presentation group (VB). Data on maternal and neonatal outcomes were compared between groups. RESULTS Among the 213 mothers and 426 infants (213 twin pairs), there were 140 women in the VV group and 73 women in the VB group (65.73% vs. 34.27%). Infants in the VB group had a higher incidence of admission to NICU (51.43% vs. 68.49%, p = 0.017), lower 1-min (11.43% vs. 28.77%, p < 0.001) and 5-minute Apgar scores (1.43% vs. 4.11%, p = 0.043) for the second twin. However, after the adjustment for sex of the twin, birth weight, chorionicity, and gestational age, the greater risk of admission to NICU and low 5-min Apgar score was no longer significantly different. CONCLUSION VB twins are at no greater overall risk of a poor outcome due to breech presentation in the second twin. However, the presentation of the second fetus represents a risk factor for a low 1-min Apgar score. Obstetricians and midwives should consider appropriate interventions for second twins who present breech versus vertex.
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Affiliation(s)
- Huahua Liu
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, China
| | - Shuhan Yan
- Medical College of Nantong University, Nantong, China
| | - Fan Wu
- Medical College of Nantong University, Nantong, China
| | - Ting Bai
- Medical College of Nantong University, Nantong, China
| | - Feng Zhang
- Medical College of Nantong University, Nantong, China
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Lee SJ, Garcia GGP, Stanhope KK, Platner MH, Boulet SL. Interpretable machine learning to predict adverse perinatal outcomes: examining marginal predictive value of risk factors during pregnancy. Am J Obstet Gynecol MFM 2023; 5:101096. [PMID: 37454734 DOI: 10.1016/j.ajogmf.2023.101096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The timely identification of nulliparas at high risk of adverse fetal and neonatal outcomes during pregnancy is crucial for initiating clinical interventions to prevent perinatal complications. Although machine learning methods have been applied to predict preterm birth and other pregnancy complications, many models do not provide explanations of their predictions, limiting the clinical use of the model. OBJECTIVE This study aimed to develop interpretable prediction models for a composite adverse perinatal outcome (stillbirth, neonatal death, estimated Combined Apgar score of <10, or preterm birth) at different points in time during the pregnancy and to evaluate the marginal predictive value of individual predictors in the context of a machine learning model. STUDY DESIGN This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be data, a prospective cohort study in which 10,038 nulliparous pregnant individuals with singleton pregnancies were enrolled. Here, interpretable prediction models were developed using L1-regularized logistic regression for adverse perinatal outcomes using data available at 3 study visits during the pregnancy (visit 1: 6 0/7 to 13 6/7 weeks of gestation; visit 2: 16 0/7 to 21 6/7 weeks of gestation; visit 3: 22 0/7 to 29 6/7 weeks of gestation). We identified the important predictors for each model using SHapley Additive exPlanations, a model-agnostic method of computing explanations of model predictions, and evaluated the marginal predictive value of each predictor using the DeLong test. RESULTS Our interpretable machine learning model had an area under the receiver operating characteristic curves of 0.617 (95% confidence interval, 0.595-0.639; all predictor variables at visit 1), 0.652 (95% confidence interval, 0.631-0.673; all predictor variables at visit 2), and 0.673 (95% confidence interval, 0.651-0.694; all predictor variables at visit 3). For all visits, the placental biomarker inhibin A was a valuable predictor, as including inhibin A resulted in better performance in predicting adverse perinatal outcomes (P<.001, all visits). At visit 1, endoglin was also a valuable predictor (P<.001). At visit 2, free beta human chorionic gonadotropin (P=.001) and uterine artery pulsatility index (P=.023) were also valuable predictors. At visit 3, cervical length was also a valuable predictor (P<.001). CONCLUSION Despite various advances in predictive modeling in obstetrics, the accurate prediction of adverse perinatal outcomes remains difficult. Interpretable machine learning can help clinicians understand how predictions are made, but barriers exist to the widespread clinical adoption of machine learning models for adverse perinatal outcomes. A better understanding of the evolution of risk factors for adverse perinatal outcomes throughout pregnancy is necessary for the development of effective interventions.
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Affiliation(s)
- Sun Ju Lee
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (Ms Lee and Dr Garcia).
| | - Gian-Gabriel P Garcia
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA (Ms Lee and Dr Garcia)
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (Drs Stanhope, Platner, and Boulet)
| | - Marissa H Platner
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (Drs Stanhope, Platner, and Boulet)
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (Drs Stanhope, Platner, and Boulet)
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Ehrhardt H, Aubert AM, Ådén U, Draper ES, Gudmundsdottir A, Varendi H, Weber T, Zemlin M, Maier RF, Zeitlin J. Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2332413. [PMID: 37672271 PMCID: PMC10483322 DOI: 10.1001/jamanetworkopen.2023.32413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023] Open
Abstract
Importance The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. Objective To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. Design, Setting, and Participants This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Exposures Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Main Outcomes and Measures Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. Results From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). Conclusions and Relevance This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
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Affiliation(s)
- Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Adrien M. Aubert
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Anna Gudmundsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Tom Weber
- University of Copenhagen, Copenhagen, Denmark
| | - Michael Zemlin
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
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12
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Njie AE, Nyandiko WM, Ahoya PA, Moutchia JS. A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya. PLoS One 2023; 18:e0285828. [PMID: 37224111 DOI: 10.1371/journal.pone.0285828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings. OBJECTIVE This study determined how effectively the APGAR score is used to diagnose birth asphyxia in comparison to the gold standard (umbilical cord blood pH <7 with neurologic involvement) at Moi Teaching and Referral Hospital (MTRH), and identified healthcare provider factors that affect ineffective use of the score. METHODS Using a quantitative cross-sectional hospital-based design, term babies born in MTRH who weighed ≥2500g were randomly and systematically sampled; and healthcare providers who assign APGAR scores were enrolled via a census. Umbilical cord blood was drawn at birth and at 5minutes for pH analysis. APGAR scores assigned by healthcare providers were recorded. Effective use of the APGAR score was determined by sensitivity, specificity, positive and negative predictive values. At a significance level of 0.05, multiple logistic regression analysis identified the independent provider-associated factors affecting ineffective use of the APGAR score. RESULTS We enrolled 102 babies, and 50 (49%) were females. Among the 64 healthcare providers recruited, 40 (63%) were female and the median age was 34.5years [IQR: 31.0, 37.0]. Assigned APGAR scores had a sensitivity of 71% and specificity of 89%, with positive and negative predictive values of 62% and 92% respectively. Healthcare provider factors associated with ineffective APGAR score use included: instrumental delivery (OR: 8.83 [95% CI: 0.79, 199]), lack of access to APGAR scoring charts (OR: 56.0 [95% CI: 12.9, 322.3]), and neonatal resuscitation (OR: 23.83 [95% CI: 6.72, 101.99]). CONCLUSION Assigned APGAR scores had low sensitivity and positive predictive values. Healthcare provider factors independently associated with ineffective APGAR scoring include; instrumental delivery, lack of access to APGAR scoring charts, and neonatal resuscitation.
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Affiliation(s)
- Albertine Enjema Njie
- Department of Child Health and Pediatrics, College of Health Sciences-Moi University, Eldoret, Kenya
| | - Winstone Mokaya Nyandiko
- Department of Child Health and Pediatrics, College of Health Sciences-Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Phinehas Ademi Ahoya
- Directorate of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jude Suh Moutchia
- Department of Biostatistics, Epidemiology and Informatics -Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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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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14
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Rozycki HJ, Yitayew M. The Apgar score in clinical research: for what, how and by whom it is used. J Perinat Med 2022; 51:580-585. [PMID: 36410713 DOI: 10.1515/jpm-2022-0340] [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: 07/12/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To review how the Apgar score is used in published clinical research as well as who uses it, and how this may have changed between 1989-90 and 2018-19. METHODS Pubmed search for English publications using MeSH Terms "apgar score" OR "apgar" AND "score" AND "humans" for epochs 1989-90 & 2018-19. The location and specialty of first author, primary purpose and how the Apgar score was used was recorded. RESULTS There was a 61% increase in number of publications in 2018-19 compared to 1989-90, from all regions except North America. The most common purpose for using the Apgar was to assess newborn status after pregnancy/delivery interventions. There were 50 different definitions of a significant score. Definition of significance was influenced by specialty in 2018-19 and by study purpose in both epochs. CONCLUSIONS Most studies using the Apgar score are focused on the mother. There is no consistent definition of a significant score. Development of any future newborn assessment tools should account for the multiple purposes for which the Apgar score is used.
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Affiliation(s)
- Henry J Rozycki
- Division of Neonatal Medicine, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Miheret Yitayew
- Division of Neonatal Medicine, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
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15
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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: 1.0] [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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Abstract
BACKGROUND The Apgar score is the most common score used to quantify neonatal status after birth. It is routinely used in clinical practice and research. However, since its introduction there have been significant changes in peripartum and neonatal management, our understanding of neonatal physiology, and changes in data analysis capabilities. PURPOSE To assess the Apgar score's reliability and validity in the context of today's clinical and research environments. METHOD PubMed was searched using the term "Apgar." Just over 22,000 titles were identified. Full-text articles were obtained if they addressed the Apgar score's use, reliability, and validity, or if the score was a primary outcome measure. This was followed by a hand search using the same criteria. The 505 identified articles build the basis for this discussion of the Apgar score's reliability and validity. FINDINGS Multiple positive and negative aspects of the Apgar score's reliability and validity were identified. Some facets needed to evaluate reliability and validity do not seem to have been addressed in the literature. Overall, the identified concerns can introduce bias into outcomes obtained via the use of the Apgar score in both clinical practice and research. IMPLICATIONS FOR PRACTICE The Apgar score is no longer used to determine neonatal management in the delivery room. IMPLICATIONS FOR RESEARCH The use of the Apgar score in research may introduce bias into outcomes. As discussed in the Video Abstract, researchers need to address and improve the score's weaknesses or consider developing a new tool better suited to today's research needs. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=45.
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17
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Eckart F, Kaufmann M, O'Donnell CPF, Mense L, Rüdiger M. Survey on currently applied interventions in neonatal resuscitation (SCIN): A study protocol. Front Pediatr 2022; 10:1056256. [PMID: 36699288 PMCID: PMC9868920 DOI: 10.3389/fped.2022.1056256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Around 140 million children are born every year and post-natal transition is uncomplicated in the vast majority. However, around 5%-15% of neonates receive supportive interventions during transition. Recent data on the interventions used is scarce. More data on the frequencies with which these interventions are used is needed to evaluate neonatal resuscitation, guide recommendations and to generate hypotheses for further research. The following protocol describes an international, multicentre survey on the interventions currently applied during neonatal resuscitation. OBJECTIVES To determine the frequencies at which different supportive interventions recommended by European Resuscitation Council (ERC) guidelines for neonatal resuscitation are used. To compare the frequencies between hospitals and patient groups and to investigate possible factors influencing any differences found. METHODS Participating hospitals will collect data on all interventions performed during neonatal resuscitation over a period of 6 months. All hospitals providing perinatal care are eligible regardless of size and designated level of neonatal care. Every neonate requiring more interventions than basic drying and tactile stimulation during the first 30 min of life will be included. The targeted sample size is at least 4,000 neonates who receive interventions. After anonymization, the data is pooled in a common database and descriptive and statistical analysis is performed globally and in subgroups. Possible correlations will be investigated with phi coefficient and chi square testing. ETHICS AND DISSEMINATION Consent of the institutional review board of the Technical University Dresden was obtained for the local data collection under the number BO-EK-198042022. Additionally, approval of local ethical or institutional review boards will be obtained by the participating hospitals if required. Results will be published in peer-reviewed journals and presented at suitable scientific conferences.
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Affiliation(s)
- Falk Eckart
- Saxony Center for Feto/Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany.,Neonatology & Pediatric Intensive Care Medicine, Department of Pediatrics, Medical Faculty, TU Dresden, Dresden, Germany
| | - Maxi Kaufmann
- Saxony Center for Feto/Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany.,Neonatology & Pediatric Intensive Care Medicine, Department of Pediatrics, Medical Faculty, TU Dresden, Dresden, Germany
| | - Colm P F O'Donnell
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Lars Mense
- Saxony Center for Feto/Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany.,Neonatology & Pediatric Intensive Care Medicine, Department of Pediatrics, Medical Faculty, TU Dresden, Dresden, Germany
| | - Mario Rüdiger
- Saxony Center for Feto/Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany.,Neonatology & Pediatric Intensive Care Medicine, Department of Pediatrics, Medical Faculty, TU Dresden, Dresden, Germany
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18
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van Beek PE, Andriessen P, Onland W, Schuit E. Prognostic Models Predicting Mortality in Preterm Infants: Systematic Review and Meta-analysis. Pediatrics 2021; 147:peds.2020-020461. [PMID: 33879518 DOI: 10.1542/peds.2020-020461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Prediction models can be a valuable tool in performing risk assessment of mortality in preterm infants. OBJECTIVE Summarizing prognostic models for predicting mortality in very preterm infants and assessing their quality. DATA SOURCES Medline was searched for all articles (up to June 2020). STUDY SELECTION All developed or externally validated prognostic models for mortality prediction in liveborn infants born <32 weeks' gestation and/or <1500 g birth weight were included. DATA EXTRACTION Data were extracted by 2 independent authors. Risk of bias (ROB) and applicability assessment was performed by 2 independent authors using Prediction model Risk of Bias Assessment Tool. RESULTS One hundred forty-two models from 35 studies reporting on model development and 112 models from 33 studies reporting on external validation were included. ROB assessment revealed high ROB in the majority of the models, most often because of inadequate (reporting of) analysis. Internal and external validation was lacking in 41% and 96% of these models. Meta-analyses revealed an average C-statistic of 0.88 (95% confidence interval [CI]: 0.83-0.91) for the Clinical Risk Index for Babies score, 0.87 (95% CI: 0.81-0.92) for the Clinical Risk Index for Babies II score, and 0.86 (95% CI: 0.78-0.92) for the Score for Neonatal Acute Physiology Perinatal Extension II score. LIMITATIONS Occasionally, an external validation study was included, but not the development study, because studies developed in the presurfactant era or general NICU population were excluded. CONCLUSIONS Instead of developing additional mortality prediction models for preterm infants, the emphasis should be shifted toward external validation and consecutive adaption of the existing prediction models.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands;
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands.,Department of Applied Physics, School of Medical Physics and Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wes Onland
- Department of Neonatology, Amsterdam University Medical Centers and University of Amsterdam, Amsterdam, Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands; and.,Cochrane Netherlands, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
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19
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European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161:291-326. [PMID: 33773829 DOI: 10.1016/j.resuscitation.2021.02.014] [Citation(s) in RCA: 289] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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20
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Bawazeer M, Alsalamah R, Almazrooa D, Alanazi S, Alsaif N, Alsubayyil R, Althubaiti A, Mahmoud A. Neonatal hospital readmissions: Rate and associated causes. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_64_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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21
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Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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22
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Wyllie J. Is it time for neonatal Utstein? Resuscitation 2020; 152:201-202. [PMID: 32389597 DOI: 10.1016/j.resuscitation.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jonathan Wyllie
- James Cook University Hospital, South Tees NHS FT, Marton Road, Middlesbrough TS43BW, UK.
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23
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Affiliation(s)
- Mario Rüdiger
- Saxony Center for Feto-Neonatal Health, Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Henry J Rozycki
- Children's Hospital of Richmond, Division of Neonatal Medicine, Virginia Commonwealth University, Richmond
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24
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Getachew B, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia. Int J Pediatr 2020; 2020:9896127. [PMID: 32206062 PMCID: PMC7077037 DOI: 10.1155/2020/9896127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Apgar score is currently an accepted method for newborn infant assessment immediately after delivery. Low fifth minute Apgar score was strongly associated with the risk of neonatal and infant death. Even though much has been done, still, the levels of neonatal mortality in sub-Saharan African countries including Ethiopia were significant. Therefore, this study is aimed at identifying the risk factors so as providing strategies for decreasing the morbidity and mortality of newborns and identifying determinants of low fifth minute Apgar score among newborns delivered in Jimma University Medical Center, Southwest Ethiopia, 2018. METHOD Institution-based cross-sectional study was conducted involving 366 neonates delivered at Jimma University Medical Center. Data was collected by using interview questionnaire. Apgar score was assessed by standard tool at the 1st, 5th, and 10th minutes after birth and only 5th minute Apgar score was used as outcome variable. Consecutive sampling technique was used to select the participants. The collected data were analyzed using SPSS version 20.0. Chi-square test was done at bivariate level and P value was used to select candidate variables for multivariate analysis. Finally, a 95% confidence interval was used to assess significance. RESULTS A response rate of this study was 95%. The proportion of low 5th minute Apgar score in this study was 11.5%. Prolonged duration of labor (AOR = 15.18, 95% CI: 5.51-40.27), maternal history of khat use (AOR = 3.21, 95% CI: 1.26-8.85), and low birth weight (AOR = 1.65, 95% CI: 1.02-3.11) were predictors of low fifth minute Apgar score. CONCLUSION About one tenth of newborns were having low 5th minute Apgar score. The likelihood of low 5th minute Apgar score was found to increase with prolonged duration of labor, history of mother's khat use, and low birth weight.
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Affiliation(s)
- Bekalu Getachew
- Department of Biomedical Sciences (Anatomy), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tesema Etefa
- Department of Biomedical Sciences (Anatomy), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Adissu Asefa
- Department of Biomedical Sciences (Anatomy), Collage of Health and Medical Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Behailu Terefe
- Department of Pharmacy (Clinical Pharmacy), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Diriba Dereje
- Department of Biomedical Sciences (Physiology), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
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Lara-Cantón I, Solaz A, Parra-Llorca A, García-Robles A, Millán I, Torres-Cuevas I, Vento M. Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth. Front Pediatr 2020; 8:12. [PMID: 32083039 PMCID: PMC7005009 DOI: 10.3389/fped.2020.00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Fetal to neonatal transition entails cardiorespiratory, hemodynamic, and metabolic changes coinciding with the switch from placental to airborne respiration with partial pressures of oxygen of 4-5 kPa in utero raising to 8-9 kPa ex utero in few minutes. Preterm infants have immature lung and antioxidant defense system. Very preterm infants (<32 weeks' gestation) frequently require positive pressure ventilation and oxygen to establish lung aeration, a functional residual capacity, and overcome a tendency toward hypoxemia and bradycardia in the first minutes after birth. Recent studies have shown that prolonged bradycardia (heart rate <100 beats per minute) and/or hypoxemia (oxygen saturation <80%) are associated with increased mortality and/or intracranial hemorrhage. However, despite the accumulated evidence, the way in which oxygen should be supplemented in the first minutes after birth still has not yet been clearly established. The initial inspired fraction of oxygen and its adjustment within a safe arterial oxygen saturation range measured by pulse oximetry that avoids hyper-or-hypoxia is still a matter of debate. Herewith, we present a current summary aiming to assist the practical neonatologist who has to aerate the lung and establish an efficacious respiration in very preterm infants in the delivery room.
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Affiliation(s)
| | - Alvaro Solaz
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Ana García-Robles
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Ivan Millán
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | | | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
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26
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Kalem Z, Ellibeş Kaya A, Bakırarar B, Namlı Kalem M. Fetal nuchal translucency: is there an association with birthweight and neonatal wellbeing? Turk J Obstet Gynecol 2019; 16:35-40. [PMID: 31019838 PMCID: PMC6463433 DOI: 10.4274/tjod.galenos.2019.21384] [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: 09/09/2018] [Accepted: 01/09/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the relationship between nuchal translucency (NT) values with birthweight and the wellbeing of the newborn. Materials and Methods This retrospective cohort study that included 508 patients made use of data on healthy full-term, singleton, live birth newborns in a university hospital between 2016 and 2018. The relationship between the NT multiple of the median (MoM) value and maternal body mass index, birthweight, sex, need for neonatal intensive care unit (NICU), and APGAR scores was evaluated. Similarly, the relationship between birthweight and NT MoM, and biochemical data in the first trimester was also evaluated. Results There was a positive correlation between NT and birthweight (p<0.001). The need for NICU admission increased (p=0.001), and APGAR 1st minute scores decreased (p=0.001) with increasing NT, and APGAR 5th minute scores remained unchanged (p=0.057). Conclusion The present study identified a positive correlation between first trimester NT and birthweight, and a negative correlation with the wellbeing of the neonate.
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Affiliation(s)
- Ziya Kalem
- Gürgan Clinic IVF and Women Health Center, Ankara, Turkey
| | - Aşkı Ellibeş Kaya
- Düzce University Faculty of Medicine, Department of Obstetrics and Gynecology, Düzce, Turkey
| | | | - Müberra Namlı Kalem
- Bahcesehir University, Department of Obstetrics and Gynecology, İstanbul, Turkey
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27
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Optimal Inspired Fraction of Oxygen in the Delivery Room for Preterm Infants. CHILDREN-BASEL 2019; 6:children6020029. [PMID: 30791491 PMCID: PMC6406550 DOI: 10.3390/children6020029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/20/2022]
Abstract
Postnatal adaptation of preterm infants entails a series of difficulties among which the immaturity of the respiratory system is the most vital. To overcome respiratory insufficiency, caregivers attending in the delivery room use positive pressure ventilation and oxygen. A body of evidence in relation of oxygen management in the delivery room has been accumulated in recent years; however, the optimal initial inspired fraction of oxygen, the time to achieve specific oxygen saturation targets, and oxygen titration have not been yet clearly established. The aim of this review is to update the reader by critically analyzing the most relevant literature.
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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: 0.4] [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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Schardosim JM, Rodrigues NLDA, Rattner D. Parâmetros utilizados na avaliação de bem-estar do bebê no nascimento. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n2.67809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectivo: identificar parâmetros que se utilizan para evaluar el bienestar del recién nacido.Síntesis del contenido: revisión integrativa de la literatura, realizada en las bases PubMed y Biblioteca Virtual de Salud (bvs), que utilizó los descriptores “apgar score”, “neonatal outcomes”, “fetal vitality” y “health services evaluation”. El recorte temporal fue de enero del 2011 a diciembre del 2016. Se importaron los resúmenes para el software Endnote Web®, para la remoción de duplicados y los remanentes exportados para el software Covidence®, lo que permitió la selección de la muestra final por dos investigadoras, de forma independiente. La muestra final incluyó 17 estudios. Los parámetros más utilizados fueron admisión del neonato en Unidad de Cuidados Intensivos en las primeras 24 a 48 horas de vida y el índice de Apgar, pero hubo variaciones en la mensuración de esos parámetros entre los estudios. Otros parámetros fueron: peso al nacer, temperatura corporal, natimortalidad y mortalidad neonatal. El Apgar, a pesar de utilizado mundialmente, posibilita subjetividad en la evaluación de algunas variables; este puede evaluar la respuesta del bebé a las maniobras empleadas en el atendimiento en sala de parto, pero no debe ser un parámetro decisorio para instituir o no maniobras de reanimación.Conclusión: algunos parámetros fueron comunes entre los estudios, sin embargo pueden agregarse otros parâmetros al abordar patologías específicas. Se considera importante entrenar enfermeiros en la medición del Apgar, pues son professionales responsables por el cuidado de la madre y el bebé 24 horas del día y, en muchos servicios, por la primera atención del recién nacido.
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Rüdiger M. Resuscitating neonates: 65 years after Virginia Apgar. BMJ Paediatr Open 2017; 1:e000195. [PMID: 29637176 PMCID: PMC5862167 DOI: 10.1136/bmjpo-2017-000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mario Rüdiger
- Fachbereich Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Dresden, Dresden, Sachsen, Germany
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Dresden, Dresden, Sachsen, Germany
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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: 6.5] [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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Predicting 2-y outcome in preterm infants using early multimodal physiological monitoring. Pediatr Res 2016; 80:382-8. [PMID: 27089498 DOI: 10.1038/pr.2016.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/16/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preterm infants are at risk of adverse outcome. The aim of this study is to develop a multimodal model, including physiological signals from the first days of life, to predict 2-y outcome in preterm infants. METHODS Infants <32 wk gestation had simultaneous multi-channel electroencephalography (EEG), peripheral oxygen saturation (SpO2), and heart rate (HR) monitoring. EEG grades were combined with gestational age (GA) and quantitative features of HR and SpO2 in a logistic regression model to predict outcome. Bayley Scales of Infant Development-III assessed 2-y neurodevelopmental outcome. A clinical course score, grading infants at discharge as high or low morbidity risk, was used to compare performance with the model. RESULTS Forty-three infants were included: 27 had good outcomes, 16 had poor outcomes or died. While performance of the model was similar to the clinical course score graded at discharge, with an area under the receiver operator characteristic (AUC) of 0.83 (95% confidence intervals (CI): 0.69-0.95) vs. 0.79 (0.66-0.90) (P = 0.633), the model was able to predict 2-y outcome days after birth. CONCLUSION Quantitative analysis of physiological signals, combined with GA and graded EEG, shows potential for predicting mortality or delayed neurodevelopment at 2 y of age.
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Tweed EJ, Mackay DF, Nelson SM, Cooper SA, Pell JP. Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children. Arch Dis Child Fetal Neonatal Ed 2016; 101:F121-6. [PMID: 26297221 DOI: 10.1136/archdischild-2015-308483] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. METHODS Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. RESULTS Of the 751,369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49,962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0-3, 10.1% had ASN, compared with 9.1% of those scoring 4-7 and 6.6% of those scoring 7-10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. CONCLUSIONS Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level.
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Affiliation(s)
- Emily J Tweed
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Sally-Ann Cooper
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
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Stabilisierung und Reanimation des Neugeborenen direkt nach der Geburt. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0045-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dalili H, Sheikh M, Hardani AK, Nili F, Shariat M, Nayeri F. Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes. PLoS One 2016; 11:e0149464. [PMID: 26871908 PMCID: PMC4752486 DOI: 10.1371/journal.pone.0149464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/31/2016] [Indexed: 02/02/2023] Open
Abstract
Objectives Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar. Methods This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality. Results Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75–51.29), IVH (OR,4.8; 95%CI,1.91–12.01), and neonatal mortality (OR,20.22; 95%CI,4.22–96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups. Conclusions The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates.
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Affiliation(s)
- Hosein Dalili
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sheikh
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Amir Kamal Hardani
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firouzeh Nili
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nayeri
- Breastfeeding Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Maternal, Fetal and Neonatal Research Center, Vali-asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ahearne CE, Boylan GB, Murray DM. Short and long term prognosis in perinatal asphyxia: An update. World J Clin Pediatr 2016; 5:67-74. [PMID: 26862504 PMCID: PMC4737695 DOI: 10.5409/wjcp.v5.i1.67] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/18/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy (NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy (HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and long-term outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.
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Finn D, Boylan GB, Ryan CA, Dempsey EM. Enhanced Monitoring of the Preterm Infant during Stabilization in the Delivery Room. Front Pediatr 2016; 4:30. [PMID: 27066463 PMCID: PMC4814766 DOI: 10.3389/fped.2016.00030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
Abstract
Monitoring of preterm infants in the delivery room (DR) remains limited. Current guidelines suggest that pulse oximetry should be available for all preterm infant deliveries, and that if intubated a colorimetric carbon dioxide detector should provide verification of correct endotracheal tube placement. These two methods of assessment represent the extent of objective monitoring of the newborn commonly performed in the DR. Monitoring non-invasive ventilation effectiveness (either by capnography or respiratory function monitoring) and cerebral oxygenation (near-infrared spectroscopy) is becoming more common within research settings. In this article, we will review the different modalities available for cardiorespiratory and neuromonitoring in the DR and assess the current evidence base on their feasibility, strengths, and limitations during preterm stabilization.
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Affiliation(s)
- Daragh Finn
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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Monsieurs K, on behalf of the ERC Guidelines 2015 Writing Group, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Wyllie J, Bruinenberg J, Roehr C, Rüdiger M, Trevisanuto D, Urlesberger B. Die Versorgung und Reanimation des Neugeborenen. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0090-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 586] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:249-63. [DOI: 10.1016/j.resuscitation.2015.07.029] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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