The Association between the Five-Minute Apgar Score and Neurodevelopmental Outcomes among Children Aged 8−66 Months in Australia

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

Download Full-text

Discordant umbilical arteries in the umbilical cord entanglement: a light microscope study

Perinatal Journal ◽

10.2399/prn.21.0293009 ◽

2021 ◽

Vol 29 (3) ◽

pp. 231-237

Author(s):

İrem Şenyuva ◽

Şirin Küçük

Keyword(s):

Umbilical Cord ◽

Gestational Age ◽

Apgar Score ◽

Umbilical Artery ◽

Apgar Scores ◽

Multiple Group ◽

Significant Difference ◽

Umbilical Arteries ◽

Minute Apgar Score ◽

Umbilical Cord Entanglement

Objective The present study aimed to examine the histopathological diagnosis of the umbilical artery discordance in cases with single or multiple umbilical cord entanglement and pregnancy outcomes. Methods The vascular structure of the umbilical cord, histopathological findings of the placenta and obstetric outcomes were retrospectively examined in 50 cases. The cases were divided into two groups by the number of cord entanglement (single-multiple) and their histopathological findings and neonatal Apgar scores were assessed. Results Out of 50 cases, 38 (76%) had single and 12 (24%) had multiple cord entanglement. In 50 cases, the mean gestational age was 39.16±1.06 weeks, neonatal Apgar scores were 8.7±0.58 at 1 minute and 9.64±0.56 at 5 minute. No statistically significant difference was detected between single and multiple groups in terms of gestational age (p=0.79), 1-minute Apgar score (p=0.832) and 5-minute Apgar score (p=0.656). In histopathological examination, the diameters of umbilical arteries 1 and 2 were found to be 0.11±0.12, 0.09±0.05 µm, respectively in the single group (p=0.756) and 0.13±0.14, 0.06±0.02 µm, respectively in the multiple group (p=0.131). When the umbilical arterial diameters were compared by group, the diameter of the umbilical artery 2 was detected 0.09±0.05 µm in the single and 0.06±0.02 µm in the multiple group and statistically significant difference was detected (p=0.037). Out of 50 cases, placental hypoxia finding was detected as chorangiosis only in 10 cases (2 multiple, 8 single). Conclusion Umbilical artery discordance was detected in cases with multiple umbilical cord entanglement. However, poor pregnancy outcome was not observed in any of the cases. When multiple cord entanglement is seen during obstetric examination, umbilical artery discordance must be remembered and investigated, and also maternal-fetal condition should be considered.

Download Full-text

Indonesian local fetal-weight standard: a better predictive ability for low Apgar score of SGA neonates

Medical Journal of Indonesia ◽

10.13181/mji.v25i4.1301 ◽

2017 ◽

Vol 25 (4) ◽

pp. 228-33

Author(s):

Adly N.A. Fattah ◽

Karina N. Pratiwi ◽

Sulaeman A. Susilo ◽

Jimmy S.N. Berguna ◽

Rima Irwinda ◽

...

Keyword(s):

Apgar Score ◽

Odds Ratio ◽

Predictive Ability ◽

Fetal Weight ◽

Accurate Assessment ◽

Apgar Scores ◽

Local Populations ◽

Local Standard ◽

Reference Tools ◽

Minute Apgar Score

Background: Accurate assessment of fetal growth is one of crucial components of antenatal care. A generic reference for fetal-weight and birthweight percentiles that can be easily adapted to local populations have been developed by Mikolajczyk and colleagues. This study aimed to validate our own local percentile standard by evaluating the odds ratio (OR) of low 1st and 5th minute Apgar score for small-for-gestational age (SGA) versus those not SGA.Methods: We used the generic reference tools for fetal-weight and birthweight percentiles developed by Mikolajczyk and colleagues to create our own local standard and then defined the SGA neonates. For validation, we used the database of singleton live deliveries (2,139 birth) during January 1st to December 31st 2013 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We compared our reference with that of Hadlock and colleagues. For every reference, the OR of Apgar score <7 at 1st and 5th minutes for infants who were SGA versus those not estimated with bivariate and multivariate analyses.Results: SGA found in 35% (748/2,139) and 13% (278/2,139) of neonates using the definition derived from Indonesian standard and Hadlock’s. OR of Apgar score <7 at 1st and 5th minutes were 3.45 (95% CI=2.56–4.65) and 3.05 (95% CI=1.92–4.83) for the Indonesian local fetal-weight standard compared with respectively 2.14 (95% CI=1.65–2.76) and 1.83 (95% CI=1.21–2.77) for Hadlock and collegues’ reference.Conclusion: Indonesian local fetal-weight standard has a better ability to predict low 1st and 5th minutes Apgar scores of SGA neonates than has the Hadlock and collegues’ reference.

Download Full-text

One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada

BMJ Open ◽

10.1136/bmjopen-2018-027655 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027655 ◽

Cited By ~ 2

Author(s):

Neda Razaz ◽

Sven Cnattingius ◽

Martina Persson ◽

Kristina Tedroff ◽

Sarka Lisonkova ◽

...

Keyword(s):

British Columbia ◽

Special Needs ◽

Apgar Score ◽

Entire Range ◽

Population Based ◽

Term Infants ◽

Apgar Scores ◽

Developmental Health ◽

Rate Ratios ◽

Log Linear

ObjectivesWe investigated the associations between Apgar scores at 1 and 5 min, across the entire range of score values, and child developmental health at 5 years of age.SettingBritish Columbia, CanadaParticipantsAll singleton term infants without major congenital anomalies born between 1993 and 2009, who had a developmental assessment in kindergarten between 1999 and 2014.Main outcomes and measuresDevelopmental vulnerability on one or more domains of the Early Development Instrument and special needs requirements. Adjusted rate ratios (aRRs) and 95% CIs were estimated using log-linear regression.ResultsOf the 150 081 children in the study, 45 334 (30.2%) were developmentally vulnerable and 3644 (2.5%) had special needs. There was an increasing trend in developmental vulnerability and special needs with decreasing 1 min and 5 min Apgar scores. Compared with children with an Apgar score of 10 at 5 min, the aRR for developmental vulnerability increased steadily with decreasing Apgar score from 1.02 (95% CI 1.00 to 1.04) for an Apgar score of 9 to 1.57 (95% CI 1.03 to 2.39) for an Apgar score of 2. Among children with 1 min Apgar scores in the 7–10 range, changes in Apgar scores between 1 and 5 min were associated with significant differences in developmental vulnerability. Compared with children who had an Apgar score of 9 at 1 min and 10 at 5 min, children with an Apgar score of 9 at both 1 and 5 min had higher rates of developmental vulnerability (aRR 1.03, 95% CI 1.01 to 1.05). Compared with infants with an Apgar of 10 at both 1 and 5 min, infants with a 1 min score of 10 and a 5 min score of <10 had higher rates of developmental vulnerability (aRR 1.53, 95% CI 1.08 to 2.17).ConclusionRisks of adverse developmental health and having special needs at 5 years of age are inversely associated with 1 min and 5 min Apgar scores across their entire range.

Download Full-text

Intrapartum Asphyxia and Cerebral Palsy

PEDIATRICS ◽

10.1542/peds.83.4.653 ◽

1989 ◽

Vol 83 (4) ◽

pp. 653-654

Author(s):

MARCUS C. HERMANSEN

Keyword(s):

Cerebral Palsy ◽

Apgar Score ◽

Birth Asphyxia ◽

Fetal Distress ◽

Important Data ◽

Apgar Scores ◽

The Relationship ◽

Minute Apgar Score

Freeman and Nelson recently presented a review of the relationship between fetal distress and subsequent cerebral palsy. Their review supported the theory that most cases of cerebral palsy are not caused by birth asphyxia. However, the review and its conclusions must be interpreted cautiously because the authors omitted important data that contradict their theory. At least five studies have presented data comparing pH at birth and Apgar scores (Table). In all five studies, some infants with acidemia had a one-minute Apgar score of 7 or more.

Download Full-text

Apgar Score and Risk of Cerebral Palsy in Preterm Infants: A Population-Based Cohort Study

Neuropediatrics ◽

10.1055/s-0041-1729181 ◽

2021 ◽

Author(s):

Damjan Osredkar ◽

Ivan Verdenik ◽

Anja Troha Gergeli ◽

Ksenija Gersak ◽

Miha Lucovnik

Keyword(s):

Cerebral Palsy ◽

Preterm Infants ◽

Apgar Score ◽

Preterm Neonates ◽

Adjusted Relative Risk ◽

Term Infants ◽

Apgar Scores ◽

Risk Of Death ◽

Increased Risk ◽

Minute Apgar Score

AbstractA low Apgar score is associated with increased risk of cerebral palsy (CP) in term infants, while such association remains controversial in preterm neonates. The objective of this study was to assess association between 5-minute Apgar scores and CP in different subcategories of preterm birth based on gestational age. The Slovenian National Perinatal Information System was used to identify singleton children without congenital malformations live-born at 22 to 37 weeks of gestation between 2002 and 2010. Data were linked to the Slovenian Registry of Cerebral Palsy in children born between 2002 and 2010. CP was diagnosed at a minimum of 5 years of age. Of 11,924 children included, 241 (2.0%) died before discharge and 153 (1.3%) were diagnosed with CP. Five-minute Apgar scores <7 were significantly associated with higher risk of death or CP (compared with scores ≥9) at all preterm gestations. CP alone was associated with Apgar scores <7 only at moderately or late preterm gestation (32–36 weeks) (adjusted relative risk [aRR]: 8.27; 95% confidence interval [CI]: 1.87–36.64 for scores 0–4 and aRR: 4.96; 95% CI 1.89–13.06 for scores 5–6). In conclusion, a low 5-minute Apgar score was associated with combined outcome of neonatal death or CP in all preterm births, while in surviving preterm infants at >32 weeks a low 5-minute Apgar score was associated with CP.

Download Full-text

Perinatal Outcomes After Undergoing External Cephalic Version

International Journal of Gynecological and Obstetrical Research ◽

10.31907/2309-4400.2021.09.02 ◽

2021 ◽

Vol 9 (1) ◽

pp. 7-11

Author(s):

Jorge Duro Gomez ◽

Keyword(s):

Prognostic Factors ◽

Clinical Practice ◽

Apgar Score ◽

Perinatal Outcomes ◽

Breech Presentation ◽

External Cephalic Version ◽

P Value ◽

Apgar Scores ◽

Minute Apgar Score

: The external cephalic version (ECV) represents the standard for pregnancies at term with a non-cephalic presentation as it avoids planned caesareans. The aim of this study was to assess the caesarean rate and prognostic factors at birth after undergoing ECV, which was compared with scheduled caesareans for a non-cephalic presentation (SCG) and spontaneous cephalic presentations at birth (GG). No difference was observed between the caesarean rate of the ECV (n=65) and the GG (n=3711) groups (9.84% and 14.47%, respectively, p-value=0.30), and neither was found between the ECV group and both the GG and SCG (n=76) groups in the Apgar scores and postpartum pH, but for the five-minute Apgar score (9.98 and 9.84 in the ECV and SCG groups, respectively, p-value=0.04). This study provides further evidence for clinical practice regarding good perinatal outcomes after undergoing ECV. Further research is required to consistently prove the increase in the intrapartum caesarean rate after ECV that has been previously described in the literature, which has not been found in the present study. Keywords: External Cephalic Version, Breech Presentation, Caesarean Rate, Perinatal Outcomes, Apgar Score, Postpartum Ph.

Download Full-text

The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia

BMC Pediatrics ◽

10.1186/s12887-021-02745-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alex Yeshaneh ◽

Andargachew Kassa ◽

Zemenu Yohannes Kassa ◽

Daniel Adane ◽

Yohannes Fikadu ◽

...

Keyword(s):

Birth Weight ◽

Emotional Support ◽

Apgar Score ◽

Sampling Technique ◽

Public Hospitals ◽

Rural Residence ◽

Apgar Scores ◽

Anemia During Pregnancy ◽

Minute Apgar Score

Abstract Background Newborn morbidity and mortality are forecasted using the Apgar scores. Obstetricians worldwide have used the Apgar score for more than half a century for the assessment of immediate newborn conditions. It is a simple and convenient evaluation system that offers a standardized and effective assessment of newborn infants. Neonatal morbidity and mortality can be reduced if high-risk neonates are identified and managed adequately. This study aimed to assess the determinants of 5th minute low Apgar score among newborns at Public hospitals in Hawassa city, South Ethiopia. Methods A hospital-based unmatched case-control study was conducted at Public Hospitals in Hawassa city. Data were collected from 134 cases and 267 controls using a structured and pre-tested questionnaire by observing, interviewing, and reviewing patient cards. Newborns who delivered with a 5th minute Apgar score < 7 were considered as cases; whereas a similar group of newborns with a 5th minute Apgar score of ≥ 7 were categorized as controls. A consecutive sampling technique was employed to recruit cases, while a simple random sampling technique was used to select controls. Data entry and analysis were performed using Epi Data version 3.1 and SPSS version 20 respectively. Binary and multivariable analyses with a 95 % confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. Results After controlling for possible confounding factors, the results showed that lack of physical and emotional support during labor and delivery [AOR = 3.5, 95 %CI:1.82–6.76], rural residence [AOR = 4, 95 %CI: 2.21–7.34], lack of antenatal care follow up [AOR = 3.5, 95 % CI: 1.91–6.33], anemia during pregnancy [AOR = 2.3,95 %CI: 1.10–4.71] and low birth weight [AOR = 6.2, 95 %CI: 2.78–14.03] were determinant factors of low Apgar scores. The area under the Apgar score ROC curve was 87.4 %. Conclusions Lack of physical and emotional support, rural residence, lack of ANC follow-up, low birth weight, and anemia during pregnancy were determinant factors of a low Apgar score. `Effective health education during preconception about anemia during pregnancy and ANC will help in detecting high-risk pregnancies that lead to a low Apgar score. In addition to the standard care of using electronic fetal monitoring, increasing access to compassion ships during labor and delivery is recommended.

Download Full-text

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

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2015-308458 ◽

2015 ◽

Vol 101 (2) ◽

pp. F114-F120 ◽

Cited By ~ 19

Author(s):

Neda Razaz ◽

W Thomas Boyce ◽

Marni Brownell ◽

Douglas Jutte ◽

Helen Tremlett ◽

...

Keyword(s):

Apgar Score ◽

Minute Apgar Score

Download Full-text

PLASMA CORTICOSTEROIDS IN INFANTS WITH THE RESPIRATORY DISTRESS SYNDROME

PEDIATRICS ◽

10.1542/peds.52.6.782 ◽

1973 ◽

Vol 52 (6) ◽

pp. 782-787 ◽

Cited By ~ 1

Author(s):

Melvin Baden ◽

Charles R. Bauer ◽

Eleanor Colle ◽

George Klein ◽

Apostolos Papageorgiou ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Premature Infants ◽

Negative Correlation ◽

Apgar Score ◽

Distress Syndrome ◽

Serum Concentrations ◽

Response To Stress ◽

Minute Apgar Score

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

Download Full-text

Are the King County SIDS Data Generalizable?

PEDIATRICS ◽

10.1542/peds.92.2.304a ◽

1993 ◽

Vol 92 (2) ◽

pp. 304-304

Author(s):

JOEL E. HAAS

Keyword(s):

Growth Velocity ◽

Apgar Score ◽

Statistical Significance ◽

King County ◽

Circular Reasoning ◽

Minute Apgar Score ◽

Do So

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

Download Full-text