Abstract
To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. A retrospective study performed by analysis of medical charts (n = 7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the chi2 test (p < 0.05). In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the > or = 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.
Highlights
IntroductionPerinatal mortality, which encompasses fetal deaths and early neonatal deaths, is an indicator of maternal-infant health, reflecting both the conditions of reproductive health, which are linked to socioeconomic factors, andThe clinical evaluation of the newborn (NB) was proposed by Virginia Apgar in 1953 and 1958, and has been very useful in assessing the need for resuscitation of newborns, when applied at the 1st minute of life, and again at 5th minute(2).Since it is the only form of evaluation in developing countries, where laboratory tests may not be available, the low cost of the Apgar score is useful in identifying children who need additional care, even in the absence of laboratory data(3).There is a consensus that an Apgar score of [7,8,9,10] means that the child is healthy and that it will probably not have future problems(4)
This analysis included all the live NB of that hospital during the years 2005 to 2009 (n=7,126) and excluded the cases in which there was no recording of weight, Apgar score or possibility of evaluating the cause related to death (n=32); 7,094 records were analyzed
Data was obtained by means of the SINASC databank(13) and, in the case of the deaths (n= 136), by analysis of clinical charts of the neonatal unit of the hospital, with a survey of variables relative to weight, 1st and 5th minute Apgar scores, and in cases of death, weight, time of survival, and causes related to mortality
Summary
Perinatal mortality, which encompasses fetal deaths and early neonatal deaths, is an indicator of maternal-infant health, reflecting both the conditions of reproductive health, which are linked to socioeconomic factors, andThe clinical evaluation of the newborn (NB) was proposed by Virginia Apgar in 1953 and 1958, and has been very useful in assessing the need for resuscitation of newborns, when applied at the 1st minute of life, and again at 5th minute(2).Since it is the only form of evaluation in developing countries, where laboratory tests may not be available, the low cost of the Apgar score is useful in identifying children who need additional care, even in the absence of laboratory data(3).There is a consensus that an Apgar score of [7,8,9,10] means that the child is healthy and that it will probably not have future problems(4). The clinical evaluation of the newborn (NB) was proposed by Virginia Apgar in 1953 and 1958, and has been very useful in assessing the need for resuscitation of newborns, when applied at the 1st minute of life, and again at 5th minute(2) Since it is the only form of evaluation in developing countries, where laboratory tests may not be available, the low cost of the Apgar score is useful in identifying children who need additional care, even in the absence of laboratory data(3). There are different levels of low Apgar score, according to pathophysiologic changes It partially depends on the maturity of the fetus. Maternal conditions, such as medications, may influence the score and the very conditions of the NB influence the assessment, for example, neuromuscular or cerebral malformations and respiratory conditions(3)
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