Five-minute Apgar Scores Research Articles

Predictive Factors for Mortality in Pre-Term Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study.

Background: Necrotizing enterocolitis (NEC) is a serious neonatal condition. Over the last three decades, there has been progress in neonatal intensive care with an increase in the incidence of pre-term births. This has led to an increase in the incidence of NEC. However, research studies regarding NEC outcomes in low-income countries are scarce. Our study aimed to assess predictive factors for mortality in patients with NEC in a single center in Tunisia. Patients and Methods: We conducted a retrospective data collection through a review of the patients' medical records. All neonates with a medical or surgical management of NEC between January 1, 2010 and March 31, 2022 were included. Results: A total of 102 neonates were included with the overall survival of 47%. Outcomes of the univariable analysis showed that patients in the deceased group had lower gestational age, lower five-minute Apgar score, lower birth weight, and lower platelet count than those in the survivor group. Multivariable logistic analyses demonstrated that gestational age <32 weeks (p = 0.024; odds ratio [OR], 2.5), five-minute Apgar score <8 (p = 0.017; OR, 3.621), birth weight <1,500 g (p = 0.001; OR, 4.136), platelet count <50,000/mm3 (p = 0.029; OR, 2.5), Bell's stage 3 (p = 0.035; OR, 2.496), and sepsis during hospitalization (p < 0.001; OR, 5.971) were associated with mortality in neonates with NEC. Conclusions: Our study showed that gestational age <32 weeks, five-minute Apgar score <8, very low birth weight, severe thrombocytopenia, Bell's stage 3, and sepsis during hospitalization were predictive factors for mortality in neonates with NEC. These factors would be useful to refine treatment modalities for better disease outcomes.

Modeling gross motor developmental curves of extremely and very preterm infants using the AIMS home-video method

BackgroundMotor development is one of the first signals to identify whether an infant is developing well. For very preterm (VPT) infants without severe perinatal complications, little is known about their motor developmental curves. AimsExplore gross motor developmental curves from 3 until 18 months corrected age (CA) of VPT infants, and related factors. Explore whether separate profiles can be distinguished and compare these to profiles of Dutch term-born infants. Study designProspective cohort study with parents repeatedly recording their infant, using the Alberta Infant Motor Scale (AIMS) home-video method, from 3 to 18 months CA. SubjectsForty-two Dutch infants born ≤32.0 weeks gestational age and/or with a birthweight (BW) of <1500 g without severe perinatal complications. Outcome measuresGross motor development measured with the AIMS. ResultsIn total 208 assessments were analyzed, with 27 infants ≥five assessments, 12 with <four, and three with one assessment. Sigmoid-shaped gross motor curves show unidirectional growth and variability. No infant or parental factors significantly influenced motor development, although a trend was seen for the model where lower BW, five-minute Apgar score <7, and Dutch native-speaking parents were associated with slower motor development. Three motor developmental profiles of VPT infants were identified, early developers, gradual developers, and late bloomers, which until 12 months CA are comparable in shape and speed to profiles of Dutch term-born infants. ConclusionsVPT infants show great intra- and interindividual variability in gross motor development, with three motor profiles being distinguished. From 12 months CA onwards, VPT infants appear to develop at a slower pace. With some caution, classifying infants into motor developmental profiles may assist clinical decision-making.

Cord prolapse and the neonatal outcome

Aims and Objectives: The primary objective of this study was to determine the obstetric risk factors and the management protocol of cord prolapse in our unit through analysis of cases diagnosed over a period of 30 months. The secondary objective was to assess the neonatal outcomes that may be associated with cord prolapse.&#x0D; Materials and Methods: A retrospective analysis for a period of 30 months was done during which there were 24 cases of cord prolapse (0.19% incidence) excluding cord presentations. The obstetric variables, parameters which determine the perinatal outcome were analysed. Statistical analyses were performed with the SPSS, Chi-Square test was used to test the statistical significance.&#x0D; Results and Conclusion: The mean maternal age was 31.8±5.5 years. In 50% of the cases, labor was induced. The incidence of abnormal fetal presentation was 8%, and in two patients (8%) onset of labor was preterm. The mean diagnosis to delivery interval (DDI) was 15 minutes and 30 seconds; except for one vaginal delivery, all women underwent crash cesarean section delivery. There were no perinatal mortalities noted. It throws light onto whether DDI could be a critical determinant in deciding the neonatal outcome. Maneuvers to relieve pressure on the umbilical cord was followed but poorly documented (25%) as was the communication with the women and their partners. Various neonatal parameters such as the five-minute Apgar score, Cord pH, hypoxia ischemic encephalopathy (HIE), intubation during resuscitation and length of stay were assessed during the study which showed satisfactory neonatal outcomes.

Comparison of neonatal outcomes in pregnant women undergoing medication-assisted treatment of opioid use disorder with methadone or buprenorphine/naloxone

Introduction The number of pregnant women with opioid use disorder (OUD) has quadrupled from 1999 to 2014. Current first line treatment for OUD in pregnancy is methadone with increasing support for buprenorphine. Limited data exist on use of buprenorphine/naloxone for OUD in pregnancy despite it being standard therapy in the non-pregnant individuals. The aim of this study was to compare neonatal opioid withdrawal syndrome (NOWS) prevalence and characteristics among neonates born to women prescribed methadone and buprenorphine/naloxone. Methods This is a retrospective cohort analysis of mother–neonate dyads treated with either methadone or buprenorphine/naloxone for OUD in pregnancy who received prenatal care in the substance abuse, treatment, education, and prevention program (STEPP) clinic and delivered at OSU. Primary neonatal outcomes included: neonates diagnosed and treated for NOWS, peak scores on Modified Finnegan Neonatal Abstinence Score (FNAS), number of scores ≥9 on FNAS, and duration of treatment for NOWS. Secondary outcomes included: fetal growth restriction, preterm birth (<37 weeks), neonatal head circumference, birth weight, NICU admission, five-minute Apgar score, and length of hospitalization. Results From 2013 to 2017, we identified 588 mother–neonate dyads: 149 treated with methadone and 439 treated with buprenorphine/naloxone. Ninety-eight neonates (65.8%) in the methadone group were diagnosed with NOWS requiring pharmacological interventions compared with 170 (38.7%) in the buprenorphine/naloxone group (aOR 3.46, 95% confidence interval (CI) 2.31–5.20, p < .01). Methadone-exposed neonates were six times more likely to be treated with >1 medication for NOWS (aOR 6.32, 95% CI 2.20–18.13, p < .01). Fetal growth restriction was diagnosed more often in the methadone group compared to the buprenorphine/naloxone group (aOR 1.73, 95% CI 1.02–2.93, p < .01). Significant maternal findings were that women using methadone for OUD started PNC earlier (15w vs. 17w, p = .04) and were less likely to be taking selective serotonin-reuptake inhibitors (SSRIs) (15% vs. 25%, p = .02) compared to the buprenorphine/naloxone group. Conclusions Buprenorphine/naloxone treatment for OUD in pregnancy appears safe and has decreased NOWS and pharmacologic intervention for the neonate.

Disseminated intravascular coagulation complicating mild or asymptomatic maternal COVID-19

Background: Hypercoagulability frequently complicates moderate or severe COVID-19 and can result in venous thromboembolism, arterial thrombosis, or microvascular thrombosis. Disseminated intravascular coagulation, however, is uncommon.Objectives: We sought to describe the clinical presentation and outcome in a series of pregnant patients with mild or asymptomatic COVID-19 who had disseminated intravascular coagulation.Study Design: This is a retrospective case series. Cases were solicited via e-mails targeted to obstetrical providers in Mednax National Medical Group and a restricted maternal-fetal medicine Facebook page. Inclusion criteria were: hospital admission during pregnancy, positive test for SARS-CoV-2 within 2 weeks of admission, and maternal disseminated intravascular coagulation defined as ≥2 of the following: platelet count ≤100,000 per mm3, fibrinogen ≤200 mg/dL, prothrombin time ≥3 seconds above upper normal limit. Exclusion criteria were severe COVID-19 requiring ventilation within an hour of diagnosis of coagulopathy or use of anticoagulants at the time of diagnosis. Maternal and newborn records were abstracted and summarized with descriptive statistics.Results: Inclusion criteria were met in 19 cases from October 2020 through December 2021. Of these, 18 had not received any COVID-19 vaccine and 1 had unknown vaccination status. Median gestational age upon hospital admission was 30 weeks (interquartile range 29-34 weeks). The chief presenting symptom or sign was decreased fetal movement (56%) or non-reassuring fetal heart rate pattern (16%). COVID-19 was asymptomatic in 79%. Two of the 3 defining coagulation abnormalities were found in 89% of cases and all 3 in the remaining 11%. Aspartate aminotransferase was elevated in all cases and ≥2 times the upper normal limit in 69%. Only 2 cases (11%) had signs of preeclampsia other than thrombocytopenia or transaminase elevation. Delivery was performed on the day of admission in 74% and the next day in the remaining 26%, most often by cesarean (68%) under general anesthesia (62%) because of non-reassuring fetal heart rate pattern (63%). Postpartum hemorrhage occurred in 47%. Blood product transfusions were given in 95% of cases, including cryoprecipitate (89% of cases), fresh/frozen plasma (79%), platelets (68%) and red cells (63%). Placental histopathology was abnormal in 82%, with common findings being histiocytic intervillositis, perivillous fibrin deposition, and infarcts or necrosis. Among the 18 singleton pregnancies and 1 twin pregnancy, there were 13 live newborns (65%) and 7 stillbirths (35%). Among liveborn neonates, five-minute Apgar score was ≤5 in 54% and, among cases with umbilical cord blood gases, pH ≤7.1 was found in 78% and base deficit ≥10 meq/L in 75%. Positive COVID-19 tests were found in 62% of liveborn infants.Conclusions: Clinicians should be alert to the possibility of disseminated intravascular coagulation when a COVID-19 patient complains of decreased fetal movement in the early 3rd trimester. If time allows, we recommend evaluation of coagulation studies and ordering of blood products for massive transfusion protocol before cesarean delivery if fetal tracing is non-reassuring.

Increasing Pre-pregnancy Body Mass Index and Pregnancy Outcomes in the United States.

Introduction: As many Americans are becoming overweight or obese, increased body mass index (BMI) is fast becoming normalized. There is a need for more research that highlights the association between pre-pregnancy obesity and adverse pregnancy outcomes.Aim: To determine the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes.Methods: We utilized the United States Vital Statistics records to collate data on all childbirths in the United States between 2015 and 2019. We determined the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes using multivariate analysis. Neonatal outcomes measures include the five-minute Apgar score, neonatal unit admission, neonates receiving assisted ventilation > six hours, neonatal antibiotics use, and neonatal seizures. Maternal outcomes include cesarean section rate, mothers requiring blood transfusion, unplanned hysterectomy, and intensive care unit admission. In addition, we controlled for maternal parameters such as race/ethnicity, age, insurance type, and pre-existing conditions such as chronic hypertension and prediabetes. Other covariates include paternal race, age and education level, gestational diabetes mellitus, induction of labor, weight gain during pregnancy, gestational age at delivery, and delivery weight.Results: We studied 15,627,572 deliveries in the US Vital Statistics records between 2015 and 2019. Among these women, 3.36% were underweight, 43.19% were with a normal BMI, 26.34% were overweight, 14.73% were in the obese class I, 7.23% were in the obese class II, and 5.14% were in the obese class III. Increasing pre-pregnancy BMI was associated with significant adverse outcomes across all measures of maternal and neonatal outcomes.Conclusion: A strong association exists between increasing pre-pregnancy BMI and adverse maternal and neonatal outcomes. The higher risk of adverse pregnancy outcomes among overweight and obese women remained even after controlling for other traditional risk factors of adverse maternal and neonatal outcomes.

Diffuse Myocardial Fibrosis at Cardiac MRI in Young Adults Born Prematurely: A Cross-sectional Cohort Study.

PurposeTo measure native T1 values, a marker of diffuse fibrosis, by using cardiac MRI (CMR) in young adults born prematurely.Materials and MethodsThis secondary analysis of a prospective cohort study included young adults born moderately to extremely preterm and age-matched, term-born participants. CMR was performed with a 3.0-T imager that included cine imaging for the quantification of left ventricular (LV) and right ventricular (RV) volumes and function and native saturation recovery T1 mapping for the assessment of diffuse myocardial fibrosis. Values between preterm and term were compared by using the Student t test. Associations between T1 values and other variables were analyzed by using linear regression and multivariate regression.ResultsOf the 50 young-adult participants, 32 were born preterm (mean age, 25.8 years ± 4.2 [SD]; 23 women) and 18 were born at term (mean age, 26.2 years ± 5.4; 10 women). Native T1 values were significantly higher in participants born preterm than in participants born at term (1477 msec ± 77 vs 1423 msec ± 71, respectively; unadjusted P = .0019). Native T1 values appeared to be positively associated with indexed LV end-diastolic and end-systolic volumes (β = 2.1, standard error = 0.7 and β = 3.8, standard error = 1.2, respectively), the RV end-diastolic volume index (β = 1.3, standard error = 0.6), and the LV mass index (β = 2.5, standard error = 0.9). Higher T1 values may be associated with reduced cardiac systolic strain measures and diastolic strain measures. Five-minute Apgar scores were inversely associated with native T1 values.ConclusionYoung adults born moderately to extremely preterm exhibited significantly higher native T1 values than age-matched, term-born young adults.Keywords: MRI, Cardiac, Heart, Left Ventricle, CardiomyopathiesClinical trial registration no. NCT03245723Published under a CC BY 4.0 license Supplemental material is available for this article.

Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study

ObjectiveTo explore the clinical or sociodemographic predictors for both successful and failed extubation among Chinese extremely and very preterm infants MethodsA retrospective cohort study was carried out among extremely and very preterm infants born at less than 32 weeks of gestational age (GA). ResultsCompared with the infants who experienced extubation failure, the successful infants had higher birth weight (OR 0.997; CI 0.996–0.998), higher GA (OR 0.582; 95% CI 0.499–0.678), a caesarean section delivery (OR 0.598; 95% CI 0.380–0.939), a higher five-minute Apgar score (OR 0.501; 95% CI 0.257–0.977), and a higher pH prior to extubation (OR 0.008; 95% CI 0.001–0.058). Failed extubation was associated with older mothers (OR 1.055; 95% CI 1.013–1.099), infants intubated in the delivery room (OR 2.820; 95% CI 1.742–4.563), a higher fraction of inspired oxygen (FiO2) prior to extubation (OR 5.246; 95% CI 2.540–10.835), higher partial pressure of carbon dioxide (PCO2) prior to extubation (OR 7.820; 95% CI 3.725–16.420), and higher amounts of lactic acid (OR 1.478;95% CI 1.063–2.056). ConclusionsHigher GA, higher pre-extubation pH, lower pre-extubation FiO2 and PCO, and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants.

Predictive value of new onset versus primary meconium-stained amniotic fluid.

Transition of clear amniotic fluid to meconium-stained fluid is a relatively common occurrence during labor. However, data regarding the clinical significance and the prognostic value of the presence of meconium-stained amnionic fluid (MSAF) are scarce. This study aimed to investigate delivery and neonatal outcomes according to the presence of MSAF and the timing of the meconium passage. We used an historical cohort study at a single tertiary medical center in Israel between the years 2011 and 2018. Women were divided into two groups according to timing of meconium passage: primary MSAF (MSAF present at membrane rupture) and secondary MSAF (clear amnionic fluid that transitioned to MSAF during labor). Neonatal complication rates were compared between groups. Composite adverse neonatal outcome was defined as arterial cord blood pH &lt;7.1, 5 min Apgar score ≤7, and/or neonatal intensive care unit admission. The study cohort included 56 863 singleton term births. Of these, 9043 (15.9%) were to women who had primary MSAF, and 1484 (2.6%) to those with secondary MSAF. Secondary MSAF compared with primary MSAF increased the risks of cesarean birth and operative vaginal delivery, increased the risks of low one- and five-minute Apgar scores and low arterial cord blood pH, and increased hospital stay duration. Multivariate analysis revealed that secondary MSAF was independently associated with an increased risk of composite adverse neonatal outcome (OR1.68, 95% CI 1.25-2.24, p&lt; 0.001) compared with primary MSAF. In this sample, secondary MSAF was associated with more adverse neonatal outcomes than primary MSAF. Closer monitoring of fetal well-being may be prudent in these cases.

Distributed Big Data Analytics Method for the Early Prediction of the Neonatal 5-Minute Apgar Score before or during Birth and Ranking the Risk Factors from a National Dataset

One-minute and five-minute Apgar scores are good measures to assess the health status of newborns. A five-minute Apgar score can predict the risk of some disorders such as asphyxia, encephalopathy, cerebral palsy and ADHD. The early prediction of Apgar score before or during birth and ranking the risk factors can be helpful to manage and reduce the probability of birth producing low Apgar scores. Therefore, the main aim of this study is the early prediction of the neonate 5-min Apgar score before or during birth and ranking the risk factors for a big national dataset using big data analytics methods. In this study, a big dataset including 60 features describing birth cases registered in Iranian maternal and neonatal (IMAN) registry from 1 April 2016 to 1 January 2017 is collected. A distributed big data analytics method for the early prediction of neonate Apgar score and a distributed big data feature ranking method for ranking the predictors of neonate Apgar score are proposed in this study. The main aim of this study is to provide the ability to predict birth cases with low Apgar scores by analyzing the features that describe prenatal properties before or during birth. The top 14 features were identified in this study and used for training the classifiers. Our proposed stack ensemble outperforms the compared classifiers with an accuracy of 99.37 ± 1.06, precision of 99.37 ± 1.06, recall of 99.50 ± 0.61 and F-score of 99.41 ± 0.70 (for confidence interval of 95%) to predict low, moderate and high 5-min Apgar scores. Among the top predictors, fetal height around the baby’s head and fetal weight denote fetal growth status. Fetal growth restrictions can lead to low or moderate 5-min Apgar score. Moreover, hospital type and medical science university are healthcare system-related factors that can be managed via improving the quality of healthcare services all over the country.

Induction of labor in twin pregnancies – A retrospective cohort study

ObjectiveTo investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. MethodsThis retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. ResultsAmong the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40–1.04) after adjusting for maternal age and parity.Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94–7.43) vs. 7.32 (7.16–7.42), and 7.27 (6.90–7.48) vs. 7.29 (7.08–7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. ConclusionOur results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.

Low Five-Minute Apgar Score and Neurological Morbidities: Does Prematurity Modify the Association?

(1) Background: We aimed to study whether a low 5 min Apgar score is associated with pediatric neurological morbidities throughout childhood. (2) Methods: A population-based retrospective cohort study was conducted. The exposed group was defined as offspring with a 5 min Apgar score <7, and the remaining offspring served as the comparison group. The primary outcome was defined as pediatric hospitalizations with any neurological morbidity. Multivariable survival models were used to evaluate the association between the exposure and outcome while adjusting for potential confounders. Additional models were used to study this association separately among term- and preterm-born offspring. (3) Results: The study population included 349,385 singletons born between the years 1991 and 2021, 0.6% (n = 2030) of whom had a 5 min Apgar score <7 (exposed). The cohort was followed for up to 18 years (median ~ 10.6). The incidence of neurological morbidity-related hospitalizations was higher among the exposed group versus the unexposed group (11.3% versus 7.5%, hazard ratio = 1.84; 95%CI 1.58–2.13). A low 5 min Apgar score remained a significant risk factor for neurological hospitalizations after adjusting for preterm delivery, maternal age, hypertension during pregnancy, gestational diabetes mellitus, chorioamnionitis, and delivery mode (adjusted hazard ratio = 1.61; 95%CI 1.39–1.87). However, after modeling term and preterm offspring separately, a low 5 min Apgar score was independently associated with neurological hospitalizations only among offspring born at term (adjusted hazard ratio = 1.16; 95%CI 0.87–1.55 and 1.70; 95%CI 1.42–2.02 for preterm and term offspring, respectively). (4) Conclusions: A low 5 min Apgar score is independently associated with childhood neurological morbidity, specifically among term-born offspring. Although not designed to identify risk for long-term health complications, Apgar scores may be a marker of risk for short- and long-term neurological morbidities among term newborns.

Neonatal outcome in vaginal breech labor at 32\u2009+\u20090\u201436\u2009+\u20090 weeks of gestation: a nationwide, population-based record linkage study

BackgroundIn many countries, vaginal breech labor at term is an option in selected cases. However, the safety of vaginal breech labor in preterm is still unclear. Therefore our study aimed to evaluate the safety of vaginal breech labor in late preterm deliveries.DesignA retrospective register-based study.SettingMaternity hospitals in Finland, 2004–2017.ParticipantsThe study population included 762 preterm breech deliveries at 32 + 0—36 + 6 gestational weeks according to the mode of delivery, 535 (70.2%) of them were born vaginally in breech presentation, and 227 (29.8%) were delivered by non-urgent cesarean section.MethodsThe study compared short-term neonatal adverse outcomes of singleton vaginal breech deliveries with non-urgent cesarean deliveries at 32 + 0 to 36 + 6 weeks of gestation. An odd ratio with 95% confidence intervals was calculated to estimate the relative risk of adverse outcomes.Outcome measuresNeonatal death, an arterial umbilical pH below seven, a five-minute Apgar score below four and seven, admission to neonatal intensive care unit, neonatal intubation, neonatal antibiotic therapy, neonatal birth trauma, respiratory distress syndrome, neonatal convulsions, cerebral ischemia, hypoxic-ischemic encephalopathy, congenital hypotonia, and a composite of severe adverse outcomes.ResultsA five-minute Apgar scores below seven were increased in vaginal breech labor at 32 + 0 to 36 + 6 weeks of gestation compared to non-urgent cesarean sections (aOR 2.48, 95% CI 1.08–5.59). Neonatal antibiotic therapy, the admission to neonatal intensive care unit, and neonatal respiratory distress syndrome were decreased after vaginal breech labor compared to the outcomes of non-urgent cesarean section (neonatal antibiotic therapy aOR 0.60, 95% CI 0.40–0.89; neonatal NICU admission aOR 0.47, 95% CI 0.33–0.68; respiratory distress syndrome aOR 0.30, 95% CI 0.19–0.48).ConclusionVaginal breech labor at 32 + 0—36 + 6 gestational weeks does not increase severe neonatal short-term morbidity or mortality compared to cesarean section.

Five-Minute Apgar Score and the Risk of Mental Disorders During the First Four Decades of Life: A Nationwide Registry-Based Cohort Study in Denmark.

Objectives:The associations of long-term risks of the full spectrum of mental disorders with clinically reassuring but suboptimal score range 7–9 remain unclear. This study investigated these associations during up to 38 years of follow-up.Methods:In a nationwide cohort study of 2,213,822 singletons born in Denmark during 1978–2015, we used cox regression to estimate the hazard ratio (HR) of mental disorders with a 95% CI.Results:A total of 3,00,679 (13.6%) individuals were diagnosed with mental disorders. The associations between suboptimal Apgar score 7–9 and mental disorders differed by attained age. In childhood (≤ 18 years), declining Apgar scores were associated with increased risks of overall mental disorders with HRs (95% CI) of 1.13(1.11-1.15), 1.34 (1.27–1.41), and 1.48 (1.31–1.67) for Apgar scores of 7–9, 4–6, and 1–3, respectively, compared with a score of 10. A dose-response association was seen even within the score range from 9 to 7 (HR 1.11 [95% CI: 1.08–1.13], 1.14 [1.10–1.18], and 1.20 [1.14–1.27], respectively). Of note, individuals with scores of 7–9 had increased risks of organic disorders (HR: 1.27, 95% CI: 1.05–1.53), neurotic disorders (HR: 1.07, 95% CI: 1.03–1.11), and a wide range of neurodevelopmental disorders, such as intellectual disability (1.87, 1.76–1.98), childhood autism (1.13, 1.05–1.22) and attention deficit hyperactivity disorder (1.10, 1.06–1.15). In early adulthood (19–39 years), suboptimal Apgar scores 7–9 were not associated with the risks of overall and specific mental disorders.Conclusion:Infants born with clinically reassuring but suboptimal 5-min scores 7–9 are at increased risks of a wide spectrum of mental disorders in childhood.

Early Nutrition among Infants Admitted to the NICU with Cleft Lip and Palate.

The objective of this study was to examine differences in human milk feeding outcomes among infants admitted to a neonatal intensive care unit (NICU) with and without cleft lip and palate (CLP). Data were used from a sample of infants admitted to the NICU with and without CLP from the 2018 National Vital Statistics System. For baseline comparisons, Chi-square tests of independence were used to compare categorical variables, and independent samples t tests were used for continuous variables. Logistic regression models were performed to determine the odds of human milk feeding at discharge in infants admitted to the NICU with CLP. The total sample included 345,429 infants admitted to the NICU, of which 660 had CLP. Significant differences were found among the following variables when baseline comparisons were made between infants admitted to the NICU with and without CLP: mother's race, mother's education, maternal smoking record, childbirth delivery method, presence of maternal pre-pregnancy diabetes, five-minute APGAR score, multiparity record (having more than one baby at birth), gestational age, and gestational weight. After controlling for baseline differences, results indicated reduced odds of human milk feeding at discharge in infants admitted to the NICU with CLP compared to those without CLP (OR = .543; 95% CI.455,.648). Results suggest reduced odds of human milk feeding at discharge among infants admitted to the NICU with CLP compared to those without CLP. These findings emphasize the necessity of awareness and facilitation of human milk feeding in this population.

Five-minute Apgar score and outcomes in neonates of 24–28 weeks’ gestation

ObjectivesTo 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 patientsRetrospective cohort study of neonates...

THE CORRELATION BETWEEN APGAR SCORE AND GESTATIONAL AGE WITH NEONATAL SEPSIS AND ASSOCIATED MORTALITY

Background: Neonatal sepsis is increasingly recognized as an important global health problem that challenges neonatal survival. In 2018, sepsis caused approximately 15% of all neonatal deaths worldwide. Recent data regarding preterm birth and low Apgar score as risk factors for neonatal sepsis-related death have not been reported in Indonesia. Methods: This was a case-control study conducted in Dr.Soetomo General Hospital. A case group was obtained from medical records by a total sampling of all neonates diagnosed with neonatal sepsis in 2019, and a control group of non-neonatal sepsis cases was taken by random sampling. Chi-square test and logistic regression were used to analyze the data. Results: Statistical analysis showed a significant correlation between one and five-minute Apgar score <7 (p <0.001; OR=16.69, 95% CI 8.10 – 34.38 and p <0.001; OR=35.00, 95% CI 10.46 – 117.14, respectively) and preterm birth <37 weeks gestation (p <0.001, OR=7.78, 95% CI 4.25 – 14.26) with neonatal sepsis. The mortality rate of neonatal sepsis was 40.74%. Mortality was strongly associated with one and five-minute Apgar score 0 – 3 (p=0.047, OR=4.59, 95%CI 1.05 – 20.06 and p=0.024, OR=3.12 1.09 – 8.92 respectively), extreme preterm born <28 weeks gestation (p=0.043, OR=4.59, 95% CI 1.05 – 20.06 ) and very preterm born 28 – <32 weeks gestation (p=0.032, OR=3.12 1.09 – 8.92). Conclusion: Low Apgar score and preterm birth could make neonates more at risk of neonatal sepsis. Mortality in neonatal sepsis was significantly related with one and five-minute Apgar score 0 – 3 (severe birth asphyxia) and preterm birth <32 weeks gestation.

The prediction of morbidity related to vaginal delivery in nulliparous women – A secondary analysis from the genesis multicenter trial

ObjectiveIn the prospective multicenter Genesis study, we developed a prediction model for Cesarean delivery (CD) in term nulliparous women. The objective of this secondary analysis was to determine whether the Genesis model has the potential to predict maternal and neonatal morbidity associated with vaginal delivery. Study designThe national prospective Genesis trial recruited 2,336 nulliparous women with a vertex presentation between 39 + 0- and 40 + 6-weeks’ gestation from seven tertiary centers. The prediction model used five parameters to assess the risk of CD: maternal age, maternal height, body mass index, fetal head circumference and fetal abdominal circumference. Simple and multiple logistic regression analyses were used to develop the Genesis model. The risk score calculated using this model were correlated with maternal and neonatal morbidity in women who delivered vaginally: postpartum hemorrhage (PPH), obstetric anal sphincter injury (OASI), shoulder dystocia, one- and five-minute Apgar score ≤ 7, neonatal intensive care (NICU) admission, cephalohematoma, fetal laceration, nerve palsy and fractures. The morbidities associated with spontaneous vaginal delivery were compared with those associated with operative vaginal delivery (OVD). The likelihood ratios for composite morbidity and the morbidity associated with OVD based on the Genesis risk scores were also calculated. ResultsA total of 1,845 (79%) nulliparous women had a vaginal delivery. A trend of increasing intervention and morbidity was observed with increasing Genesis risk score, including OVD (p < 0.001), PPH (p < 0.008), NICU admission (p < 0.001), low Apgar score at one-minute (p < 0.001) and OASI (p = 0.009). The morbidity associated with OVD was significantly higher compared to spontaneous vaginal delivery, including NICU admission (p < 0.001), PPH (p = 0.022), birth injury (p < 0.001), shoulder dystocia (p = 0.002) and Apgar score of<7 at one-minute (p < 0.001). The positive likelihood ratios for composite outcomes (where the OVD was excluded) increases with increasing risk score from 1.005 at risk score of 5% to 2.507 for risk score of>50%. ConclusionIn women who ultimately achieved a vaginal birth, we have shown more maternal and neonatal morbidity in the setting of a Genesis nomogram-determined high-risk score for intrapartum CD. Therefore, the Genesis prediction tool also has the potential to predict a more morbid vaginal delivery.

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

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

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.