Infant Apgar Scores Research Articles

Does Early Initiation of Labor Epidural Analgesia Affect Labor Outcomes? A Randomized Clinical Trial

Background: Although epidural analgesia (EA) is a popular and effective method for pain relief during labor, significant controversy exists in terms of the impact of EA on labor outcomes and the best time for initiation of EA. Here, we aim to explore the effects of early initiation EA on the labor process in nulliparous at-term pregnant women.
 Methods: A total of 240 nulliparous women enrolled in this study. The early epidural (EE) group (n=120) consisted of women in the latent phase of labor and the late epidural (LE) group (n=120) were in the active phase of labor. Each group received 16 ml of 0.125% preservative-free isobaric bupivacaine with 50 µg fentanyl (total: 17 ml) as a primary bolus dose in the epidural space for labor analgesia and an intermittent bolus of 5-10 ml of the primary solution was administered via a catheter. The length of labor, rate of cesarean section (CS), neonatal well-being, and infant Apgar scores were recorded.
 Results: There were no statistically significant differences between the two groups regarding the duration of the first (p=.43) and second (p=.54) phases of labor. No statistically significant differences were observed between the two groups in terms of the rate of CS (p=.21), causes for CS (p=.24), and neonatal Apgar scores (p=0.84).
 Conclusion: Initiation of EA during early labor did not result in increased CS or instrumental vaginal deliveries, and did not prolong labor duration.

Effects of multidimensional exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus.

This study aimed to evaluate the effects of multidimensional quantitative exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus (GDM). A randomized controlled trial was conducted with 150 pregnant women diagnosed with gestational diabetes mellitus (GDM). Participants were randomly assigned to either the experimental group (Exp), which received a multidimensional quantitative exercise management intervention, or the control group (Con), which received standard GDM management. Results were compared between the groups included self-efficacy scores, blood glucose levels, and delivery outcomes. Exp group of pregnant women exhibited drastically superior self-efficacy scores as well as more stable blood glucose levels during pregnancy relative to Con group (P < 0.05). Moreover, visual analogue scale (VAS) of pregnant women and Apgar scores of infants in Exp group were considerably better than those in Con group (P < 0.05). In contrast to Con group, pregnant women in Exp group had considerably better labor outcomes along neonatal complication rates (P < 0.05). Multidimensional quantitative exercise management had a positive impact on pregnant women with GDM. This intervention method can improve self-efficacy levels along better blood glucose control, and enhance delivery outcomes. These findings suggested that multidimensional quantitative exercise management has potential clinical value in the management of GDM, providing an effective management strategy to improve the health conditions of both pregnant women and infants.

Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm

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. To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. 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. Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). 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. 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). 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.

Apgar Score and the Amount of Blood of Mother in Labour in Delayed Cord Clamping Period

A delay in cutting the umbilical cord in infants can increase the Apgar score in infants who experience asphyxia. Besides that, it can prevent postpartum hemorrhage from occurring. Most deaths from postpartum hemorrhage occur during the first 24 hours after delivery. This increase in the Apgar value proves that the longer the delay in the umbilical cord is carried out, even until it doesn't pulsate, the better the baby's body will be, which results in an increase in hemoglobin in the baby's body. The population in this study were all mothers in the 3-4 stage of labor in the city area. Bandar Lampung. The sample is part of the number and characteristics possessed by the population with 120 maternal. It is known the length of time delayed cord Clamping is performed on babies born (&lt;30 seconds) as many as 3 (2.5%) respondents, while umbilical cord clamping is delayed for 30-180 seconds as many as 117 (97.5%) respondents, the Apgar score in newborns in the category of mild asphyxia - not asphyxia as much as 100%, the amount of blood that came out &lt;250 grams was 93 (77.5% ) respondents and the amount of blood that came out 250 grams were 27 (22.5%) respondents. Delayed cord clamping does not increase the incidence of asphyxia and bleeding in laboring mothers, so immediate umbilical cord clamping can be performed by observing the baby's birth condition.

Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section

BackgroundNeonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe.MethodsWe carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores.ResultsFour hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5–10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6–23.1, sensitivity analysis E-value = 4.42).ConclusionsWhen providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible.Trial registrationThe clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.

Effect of General Anesthesia On Apgar Score In Relation To Induction-Delivery and Uterine-Delivery Interval

The anaesthetic drugs technique used in caesarean section should prevent fetal depressant resulting from passing of drugs through the maternal-placental barrier which can lead to adverse effects such as decreasing in Apgar score and respiratory depression in new born neonates. Apgar score is the first test given to newborn after delivery by caesarian section or normal vaginal delivery to evaluate a newborn physical condition after delivery and to determine any immediate need for extra medical or emergency care. To determine the effect of general anaesthetic drugs on the Apgar score of new-borns in relation to the induction-delivery interval and uterine delivery interval. One hundred healthy full term pregnant women underwent elective C/S, on left lateral position the pre induction with 100% oxygen by face mask, then start induction with minimum dose of Thiopentone (3mg/kg ) with ketamine (1mg/kg), followed by non-depolarization muscle relaxant atracurium(0. 5 mg/kg ). Endotracheal intubation was done and maintenance of anaesthesia with oxygen, 0.5% Halothane and atracurium (0. 1 mg/kg) till the end of surgery. Neostigmine (2.5 mg) and atropine (1.2mg) was given as antidote. During operation the heart rates, blood pressures and oxygen saturation (pulse oxymeter) were monitored. Oxytocin (20 units) or ergometrine (0.8 mg) is injected intravenously after clamping the cord, then (tramadol 75 mg + midazolam 5mg) was given. Induction- delivery interval and uterine-delivery interval was noted using a stopwatch. After delivery the baby’s Apgar score was noted at 1, 5 and 10 min. and proper resuscitation was done. Low Apgar score and low to moderate score at one minute was found when induction –delivery interval up to five minutes and more than 10 minutes also low and low to moderate score of infants when uterine – delivery interval more than 120 seconds. One minute Apgar score of infants were affected by induction-delivery time (≤ 5 min and &gt; 10 min) and uterine –delivery interval (&gt;120 sec).

Predicting Low Cognitive Ability at Age 5-Feature Selection Using Machine Learning Methods and Birth Cohort Data.

Objectives: In this study, we applied the random forest (RF) algorithm to birth-cohort data to train a model to predict low cognitive ability at 5years of age and to identify the important predictive features. Methods: Data was from 1,070 participants in the Irish population-based BASELINE cohort. A RF model was trained to predict an intelligence quotient (IQ) score ≤90 at age 5years using maternal, infant, and sociodemographic features. Feature importance was examined and internal validation performed using 10-fold cross validation repeated 5 times. Results The five most important predictive features were the total years of maternal schooling, infant Apgar score at 1min, socioeconomic index, maternal BMI, and alcohol consumption in the first trimester. On internal validation a parsimonious RF model based on 11 features showed excellent predictive ability, correctly classifying 95% of participants. This provides a foundation suitable for external validation in an unseen cohort. Conclusion: Machine learning approaches to large existing datasets can provide accurate feature selection to improve risk prediction. Further validation of this model is required in cohorts representative of the general population.

Predicting low cognitive ability at age 5 using machine learning methods and birth cohort data

Abstract Background Early intervention is essential to address disparities in cognitive development. Current developmental screening will not detect the vast majority of children who go on to have below average cognitive ability at school age. In this study, we applied the random forest (RF) algorithm, a highly interpretable machine learning method, to birth-cohort data to train a model to predict low cognitive ability at 5 years of age using perinatal features. Methods Data was from 1,070 participants in the Irish population-based BASELINE birth cohort. A RF model was trained to predict an intelligence quotient (IQ) score &amp;lt;90 at age 5 years using a broad selection of maternal, infant, birth, and sociodemographic features, all of which could be easily measured at a population level in the perinatal period. Feature importance was examined using mean decrease in Gini impurity, mean decrease in accuracy, and mean minimal depth. Recursive feature elimination was used to develop a parsimonious model. Internal validation was performed using 10-fold cross validation repeated 5 times. Results The most predictive features for low cognitive ability at 5 years of age were the total years of maternal schooling, infant Apgar score at 1 minute, socioeconomic index, maternal BMI, and units of alcohol consumed in the first trimester. A parsimonious RF model based on 11 features showed excellent predictive ability, with a sensitivity of 0.89 and a specificity of 0.98, providing a foundation suitable for external validation in an unseen cohort. Conclusions Machine learning approaches to large existing datasets can provide accurate feature selection to improve risk prediction. Further validation of this model is required in additional cohorts, representative of the general population. Accurate risk prediction can facilitate targeted screening and intervention. Key messages • The application of machine learning to large population-based data can improve feature selection and accuracy in risk prediction models. • Accurate risk prediction may enable early intervention to address disparities in cognitive development. Individual interventions must occur in conjunction with population level policy changes.

Association between Abnormal Cardiotocography and Fetal Outcome: A cross-sectional study At Benha University Hospitals

Contextual information Prenatal heart rate monitoring was first used to identify conditions like foetal hypoxia and foetal acidemia, both of which may result in serious problems for the baby. Pathological CTG has been shown to correlate with conditions of the infant as measured by Apgar score and hypoxic-ischaemic encephalopathy, according to data collected from the medical literature. In the current research, we wanted to analyse the influence of aberrant CTG pattern in late prenatal period and labour on the obstetrical and neonatal outcomes, in terms of mode of delivery and Apgar score of infant. Methods: The 260 pregnant women who presented with abnormal cardiotocography between weeks 37 and 42 of their pregnancies were the subjects of a cross-sectional research conducted at Benha University Hospital's Obstetrics and Gynecology Department. Group(A) : comprise ante-natal group 130 patients ≥37 weeks with apthological non-reactive CTG . Other 130 labouring patients (ages 37 to 42 weeks) were included in Group(B), and their Suspicious CTGs were redone after they were hydrated with 1000 ml iv fluid and oxygen at 10 L/minute for 20 to 30 minutes. Finally, we filtered out the 63 women who had normal CTG and included the 67 women whose CTG was permanently pathological. The results showed that early deceleration accounted for 39 (19.80%) of cases, late deceleration accounted for 61 (30.96%) of cases, variable deceleration accounted for 24 (12.18%) of cases, reduced variability accounted for 38 (19.29%) of cases, absent variability accounted for 19 (9.64%) of cases, and no accelerations accounted for only 16 (8.12%) of cases. We identified a statistically significant link between Apgar Score at 5 Minutes and gestational age, with a considerably greater proportion of newborns having a score of 7 or above if their gestational age was less than 39 weeks. (p=0.0430). Conclusion: CTG is a valid screening indication of foetal outcome and combination of preterm and abnormal CTG related with poor APGAR score.

Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study.

The current guidelines for malaria prevention and control during pregnancy in Africa is predicated on the prevention of infection and/or disease through intermittent preventive treatment in pregnancy (IPTp), insecticide-treated nets (ITNs) and effective malaria case diagnosis and management. Concerns that increasing SP resistance in some areas of SSA may have compromised IPTp-SP efficacy prompted this contemporaneous study, designed to assess the prevalence and risk factors of sub-microscopic infection in parturient women during the low transmission season in Mutengene, a rapidly growing semi-urban area in Southwest Region, Cameroon. Pregnant women originally reporting for the establishment of antenatal clinic care during the dry season were followed-up to term and their pregnancy outcomes recorded. About 2 ml of venous blood was collected for malaria diagnosis using PfHRP2/pLDH malaria rapid diagnostic kit and light microscopy. DNA was extracted from dried blood spots by the Chelex-100 method and the Plasmodium falciparum status detected by nested PCR amplification of the 18SrRNA gene using specific predesigned primers. Of the 300 women enrolled, the proportion of malaria parasite infected as determined by microscopy, RDT and PCR was 12.9%, 16.4% and 29.4% respectively, with 39.9% overall infected with P. falciparum by microscopy and/or RDT and/or PCR and a very low-density infection, averaging 271 parasites per microliter of blood. About 25.0% (68/272) of women who were negative by microscopy were positive by PCR (submicroscopic P. falciparum infection), with primigravidae and IPTp-SP non usage identified as independent risk factors for submicroscopic P. falciparum parasitaemia while fever history (aOR = 4.83, 95% CI = 1.28-18.22, p = 0.020) was associated with risk of malaria parasite infection overall. IPTp-SP use (p = 0.007) and dosage (p = 0.005) significantly influenced whether or not the participant will be malaria parasite negative or carry submicroscopic or microscopic infection. Although Infant birthweight and APGAR score were independent of the mother's P. falciparum infection and submicroscopic status, infant's birthweight varied with the gravidity status (p = 0.001) of the mother, with significantly lower birthweight neonates born to primigravidae compared to secundigravidae (p = 0.001) and multigravidae (p = 0.003). Even in holo-endemic dry season, there exists a large proportion of pregnant women with very low density parasitaemia. IPTp-SP seems to be relevant in controlling submicroscopic P. falciparum infections, which remains common in pregnant women, and are hard to diagnose, with potentially deleterious consequences for maternal and fetal health. Future studies should be carried out in hyperendemic malaria foci where the parasitemia levels are substantially higher in order to confirm the efficacy of IPTp-SP.

Long-term follow-up of autologous peripheral blood hematopoietic stem cell transplantation for refractory lupus nephritis-a series study of 20 patients.

Autologous hematopoietic cell transplantation (ASCT) improves immunologic homeostasis in autoimmune diseases. ASCT-treated refractory lupus nephritis (LN) has been reported. Nevertheless, the long-term outcome of patients with refractory LN after ASCT remains unknown. This study reports the outcomes of 20 refractory lupus patients with 10-year of follow-up after receiving ASCT. Twenty-two patients with LN refractory to immunosuppressive therapy were enrolled. Twenty patients were examined closely and two cases died within 100 days after ASCT. Hematopoietic cell mobilization with cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) was followed by collection of CD34+ positively selected cells. The conditioning regimen consisted of intravenous cyclophosphamide, rabbit antithymocyte globulin, methylprednisolone, and G-CSF. All immunosuppressive therapies were discontinued at the start of mobilization and corticosteroids were tapered rapidly after ASCT. Data was collected from 22 patients with refractory LN treated by ASCT. 59% were female, duration of lupus before ASCT was 46 (33-71) months, and median duration of follow-up after ASCT was 89.5 (56-108) months. 20 long-term followed up patients had an average follow-up time of 92 months (63.25-109.5). Eighteen patients achieved complete remission, one patient reached partial remission, one patient without remission started peritoneal dialysis at month 12, and one patient received short-term renal replacement therapy before ASCT started hemodialysis at 84 months after transplantation. Nine patients relapsed 10 times during the follow-up, and three patients received rituximab. Two patients relapsed during pregnancy after complete response and the Apgar scores of infants were 9 and 10, respectively. All nine patients received glucocorticoids and immunosuppressive medication after relapse and responded again. The 10-year overall survival, 10-year disease-free survival rate, and 10-year renal survival were 100%, 35%, and 90%, respectively. The rate of relapse was 45%. Complications included hypocytosis, infection, B-type insulin resistance syndrome, and monoclonal immunoglobulinemia. This study suggests ASCT is effective and safety in treating refractory LN and is beneficial to improve their long-term outcomes.

The Correlation of Cord Arterial Blood Gas Analysis Results and Apgar Scores in Term Infants Without Fetal Distress.

Objective:This study aimed to evaluate the necessity of cord arterial blood gas analysis in cases without fetal distress and normal Apgar score.Materials and Methods:The cord arterial blood gas analysis and the 1- and 5-minute Apgar scores data of 1438 cases were evaluated. Newborns with fetal distress, neonates requiring cardiopulmonary resuscitation in the delivery room, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at cord arterial blood gas analysis), and pre- and post-term newborns are excluded. Following cord arterial blood gas analysis, threshold values were accepted as abnormal pH <7.2, base excess ≥ −6 mmol/L, lactate ≥ 5 mmol/L, bicarbonate < 18 mmol/L, and partial pressure of carbon dioxide ≥ 50 mmHg. We evaluated the correlation between cord arterial blood gas analysis and 1- and 5-minute Apgar scores.Results:There was a significant correlation between both 1- and 5-minute Apgar scores and cord arterial blood gas analysis values such as pH, lactate, and partial pressure of carbon dioxide (P < .001). In addition, a significant correlation was found between the 5-minute Apgar score of <7 and some cord arterial blood gas analysis abnormal threshold values (pH, bicarbonate, base excess) (P < .001). We found that some patients with mild acidemia had 1- and 5-minute Apgar scores of ≥7 in 1.9% and 2% of cases, respectively.Conclusion:The 5-minute Apgar score of 7 or higher may not be sufficient to verify the well-being of a newborn. Relying only on the Apgar scores may create the risk of missing some newborns with mild metabolic acidosis. The necessity of routine cord arterial blood gas analysis should be considered in prospective studies even if there are no signs of fetal distress and Apgar score ≥7.

Associations between low Apgar scores and mortality by race in the United States: A cohort study of 6,809,653 infants.

Apgar scores measure newborn health and are strongly associated with infant outcomes, but their performance has largely been determined in primarily white populations. Given the majority of the global population is not white, we aim to assess whether the association between low Apgar score and mortality in infants varies across racial groups. Population-based cohort study using 2016 to 2017 United States National Vital Statistics System data. The study included singleton infants born between 37+0 and 44+6 weeks to mothers over 15 years, without congenital abnormalities. We looked at 3 different mortality outcomes: (1) early neonatal mortality; (2) overall neonatal mortality; and (3) infant mortality. We used logistic regression to assess the association between Apgar score (categorized as low, intermediate, and normal) and each mortality outcome, and adjusted for gestational age, sex, maternal BMI, education, age, previous number of live births, and smoking status, and stratified these models by maternal race group (as self-reported on birth certificates). The cohort consisted of 6,809,653 infants (52.8% non-Hispanic white, 23.7% Hispanic, 13.8% non-Hispanic black, 6.6% non-Hispanic Asian, and 3.1% non-Hispanic other). A total of 6,728,829 (98.8%) infants had normal scores, 63,467 (0.9%) had intermediate scores, and 17,357 (0.3%) had low Apgar scores. Compared to infants with normal scores, low-scoring infants had increased odds of infant mortality. There was strong evidence that this association varied by race (p < 0.001) with adjusted odds ratios (AORs) of 54.4 (95% confidence interval [CI] 49.9 to 59.4) in non-Hispanic white, 70.02 (95% CI 60.8 to 80.7) in Hispanic, 23.3 (95% CI 20.3 to 26.8) in non-Hispanic black, 100.4 (95% CI 74.5 to 135.4) in non-Hispanic Asian, and 26.8 (95% CI 19.8 to 36.3) in non-Hispanic other infants. The main limitation was missing data for some variables, due to using routinely collected data. The association between Apgar scores and mortality varies across racial groups. Low Apgar scores are associated with mortality across racial groups captured by United States (US) records, but are worse at discriminating infants at risk of mortality for black and non-Hispanic non-Asian infants than for white infants. Apgar scores are useful clinical indicators and epidemiological tools; caution is required regarding racial differences in their applicability.

Sleep During Pregnancy.

This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy. Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women. Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.

COVID-19 Positive Neonates from Pregnant Women with COVID-19 in Kasih Ibu Hospital Surakarta

Kasih Ibu Hospital from October 2019 to January 2021 has become the referral maternal COVID-19 hospital in Surakarta, Central Java. Until now, research on pregnant women with COVID-19 in Indonesia is still very limited, it is still unknown whether there are possibility of vertical transmission from mother to baby, while pregnant women are among the vulnerable population. The purpose of this study is to provide an overview of the findings of positive infant outcomes for COVID-19 in pregnant women with confirmed COVID-19 at Kasih Ibu Hospital, Surakarta. Data collection was carried out by tracing medical records which were then presented in the form of distributions based on gestational age, infant birth weight, infant APGAR score, and infant COVID-19 status. Out of 62 pregnant women confirmed positive for COVID-19, 20 babies (32.3%) had PCR swab tests positive for COVID-19. All babies were born in good shape (APGAR score 8-10) and 4 babies were found with low birth weight, one of whom also had hypospadias. There were no reports of neonatal asphyxia and infant mortality.

Qur’anic Bibliotherapy Intervention in Pregnant Women Experiencing Anxiety During the COVID-19 Pandemic in Indonesia: A Qualitative Exploratory Study

BACKGROUND: The disease caused by coronavirus-19 (COVID-19) has been stated as a global epidemic by the WHO. The COVID-19 pandemic adds many risk factors to maternal mental health during the perinatal period. The impact of anxiety during pregnancy is adverse obstetric consequences such as premature birth, inadequate antenatal care, requests for elective cesarean delivery, low APGAR scores of infants, and postpartum depression. Nursing interventions to overcome anxiety can be done through spiritual and religious intervention approaches. One of the spiritual interventions for the Muslim population to improve religious coping is Qur’anic Bibliotherapy (QB) as Islamic bibliotherapy. AIM: This study aimed to explore the use of QB interventions for pregnant women experiencing anxiety during the COVID-19 pandemic. METHODS: A qualitative exploratory study was conducted to explore the experience of the intervention given to the informant. The qualitative samples were ten respondents with moderate-to-severe anxiety levels. The anxiety instrument used was the Zung Anxiety Scale. RESULTS: The themes obtained from in-depth interviews with semi-structured interviews were recognizing COVID-19 and its perceived impact, the impetus for changing resilience to the COVID-19 pandemic, parents’ role, and the benefits of QB for pregnant women in the COVID-19 pandemic. CONCLUSIONS: QB encourages informants’ positive thinking, feeling, spiritual, and attitude patterns. QB can be used as a complementary Islamic intervention for health workers, especially nurses, in providing nursing care to Muslim patients.

Relationship between Serum TSH Level and Adverse Pregnancy Outcome in Advanced Maternal Age.

The purpose of this paper is to explore the relationship between serum thyroid-stimulating hormone (TSH) levels and adverse pregnancy outcomes in advanced maternal age. A total of 97 elderly parturient women who were treated in our hospital from June 2020 to March 2021 are included in this study. According to the TSH level, the parturient women are divided into three groups, including A (<0.25 μIU/ml), B (>4.00 μIU/ml), and C (0.25-4.00 μIU/ml) groups. The clinical data of all parturients are collected and sorted out. The serum levels of TSH, free triiodothyronine (FT3), and free thyroxine (FT4) are measured by chemiluminescence immunoassay. The levels of immunoglobulin (Ig) A, IgG, and IgM are determined by immunoturbidimetry. The incidence of adverse pregnancy outcomes is analyzed. The birth weight and Apgar score of newborns in the three groups are compared. The TSH level in group A is significantly lower than that in groups B and C, but the levels of FT3 and FT4 in group A are notably higher than those in groups B and C (P < 0.05). The levels of IgA, IgG, and IgM in group A are significantly higher than those in groups B and C (P < 0.05). The incidence of adverse pregnancy outcomes in group C is 2.38%, which is obviously lower than the 20.00% in group A and 17.14% in group B (P < 0.05). The birth weight and Apgar score of infants in group A and group B are significantly lower than those in group C (P < 0.05). TSH has a great influence on the pregnancy outcome in advanced maternal age, which should be paid more attention in clinic.

Apgar scores correlate with survival rate at discharge in extremely preterm infants with gestational age of 25-27 weeks

Low Apgar score is associated with increased risk of death in preterm or full-term infants. However, the use of Apgar score to assess extremely preterm (EP) infants is controversial. In this study, we characterized the distribution of Apgar scores in EP infants with gestational age between 25 and 27 weeks, and investigated the association of Apgar score with survival rate at discharge by analyzing the clinical data of the EP infants discharged between January 2008 and December 2017 from 26 neonatal intensive care units in Guangdong Province, China. A total of 1567 infants with gestational age of 26.84±0.79 weeks and birth weight of 951±169 grams were involved in our study. The Apgar score increased with gestational age from 25 to 27 weeks and with time from birth from 1 to 10 min. The survival rate increased with a higher Apgar score, but no significant difference was found for 1-min Apgar score and the survival rate between infants with 25 or 26 weeks of gestation or 5-min Apgar score in infants with 25 weeks of gestation. The Apgar score is associated with survival of EP infants.

Comparison of The Effects of General and Spinal on Apgar Scores of Babies Born Through Caesarean Section in RSUP Haji Adam Malik Medan from 2018 to 2019

Background. General anesthesia and spinal anesthesia in cesarean section both have advantages and disadvantages. The scoring system of APGAR is a standardized tool that can inform the condition of newborn infants, which might be influenced by gestational age, medication, resuscitation, cardiorespiratory and neurological conditions of the mother. This study aimed to compare the effect of general and spinal anesthesia usage to the APGAR score of newborn infants at Haji Adam Malik General Hospital Medan. Methode. This study uses an observational-analytic design with a cross-sectional approach, conducted using secondary data through the medical records of mothers who gave birth through cesarean section and obtained at the Medical Record Installation at the Haji Adam Malik Hospital Medan from 2018 to 2019. Result. In spinal anesthesia, there are 52 samples for a score of 8-10. Whereas in general anesthesia, there are 52 samples to score 8-10. The APGAR score of 1 minute in infants born through cesarean section under spinal anesthesia had an average of 8.63, with general anesthesia of 8.00 (p=0.001). The 5-minute APGAR score in infants born through cesarean section under spinal anesthesia had an average of 9.85, and with general anesthesia of 8.67 (p=1.000). Conclusion: The 1-minute APGAR score for infants using spinal anesthesia showed a statistically better effect than the 1-minute APGAR score for infants using general anesthesia.

Relationship between bronchopulmonary dysplasia, long-term lung function, and vitamin D level at birth in preterm infants.

BackgroundWe aimed to investigate the relationship between the level of serum 25 hydroxyvitamin D [25-(OH)D] at birth and the complications of bronchopulmonary dysplasia (BPD), as well as the long-term lung function of preterm infants.MethodsA total of 286 premature infants who were admitted to the neonatal ward of Haikou Maternal and Child Health Hospital from January 2018 to December 2020 and met the inclusion criteria were selected as the research objects. The level of serum 25(OH)D at birth was detected. The children were divided into a BPD group (79 cases) and a non-BPD group (207 cases). The case information and basic data of the children were recorded. The children were followed up 6 months after correcting the gestational age of 40 weeks, and their long-term lung function development was reported. Logistic regression analysis was used to evaluate the high-risk factors of BPD in preterm infants.ResultsThe 1- and 5-minute Apgar scores of preterm infants in the BPD group were significantly lower than those in the non-BPD group. Also, the combined neonatal pneumonia, neonatal asphyxia, hospital stay, and total oxygen therapy time in the BPD group were substantially higher than those in the non-BPD group. The mean value of serum 25-(OH)D at birth in the BPD group (33.7±15.1 nmol/L) was significantly lower than that in the non-BPD group (49.5±19.6 nmol/L). Compared with the non-BPD group, the respiratory rate (RR) in the BPD group increased significantly, while the tidal volume (VT), inspiratory to expiratory ratio (TI/TE), ratio of time to peak tidal expiratory flow to total expiratory time (TPEF/TE), and 25% tidal expiratory flow rate (TEF25%) decreased markedly (P<0.05). Total oxygen therapy time, neonatal pneumonia, neonatal asphyxia, and serum 25-(OH)D level at birth were identified as independent risk factors for BPD in preterm infants.ConclusionsThe level of serum 25-(OH)D in preterm infants at birth is closely related to the occurrence of BPD and long-term lung function damage, and is affected by multiple high-risk factors. This study provides a theoretical basis for the individualized treatment of preterm infants and the early prevention of BPD.