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PubMed1992

Sigtuna score versus Apgar score: simple and practical evaluation of the newborn.

In this prospective study, we investigated the relation between the Apgar and Sigtuna scores in 1605 newborns. In 169 of them, umbilical arterial blood specimens were analysed for blood gases. There were significant correlations between the Sigtuna and Apgar scores at 1, 5 and 10 minutes after birth (P less than 0.001). Umbilical arterial blood pH (pHua) values were shown to be correlated with both the Sigtuna and Apgar scores. The Sigtuna score was similar to the Apgar score in respect of sensitivity, specificity, positive predictive value and negative predictive value in relation to pH level. We conclude that because of the simplicity of the Sigtuna score, it may be used in place of the Apgar score to establish a rapid diagnosis of asphyxia.

Apgar Score↗

PubMed1992

Application of fuzzy logic to the Apgar scoring system.

Apgar fuzzy expert system (AFES) applied fuzzy logic to the Apgar Scoring System (APG). We prepared the AFESs for both an inexperienced obstetrician (resident A) and an experienced obstetrician (specialist B) separately. We then compared their evaluations of the same 80 neonates at 1 min after birth using both the AFES and the APG. Analysis of the relationship of the general evaluation by the APG (scores below 6 or over 7) and the AFES (bad or good) to the umbilical arterial blood gases (pH below or above 7.20) showed that the sensitivities were 0.36 for the APG evaluation by resident A, 0.50 for the APG evaluation by specialist B, 0.60 for the AFES rating by resident A, and 0.71 for the AFES rating by specialist B. The specificities were 0.94, 0.95, 0.97 and 0.97, respectively. These results demonstrated that the AFES was capable of reflecting the recognition of the examiner.

Apgar Score↗

PubMed1991

The Apgar score: evolution, limitations, and scoring guidelines.

The Apgar score has been useful for nearly four decades in focusing on five physiological signs (heart rate, respiratory effort, reflex irritability, muscle tone, color) that denote the condition of an infant during the first critical minutes of life. Before the development of the system, narcotic analgesia and sedation during labor, and general anesthesia for vaginal deliveries were commonly used. Research of the scoring method has focused on the effects of these interventions on the fetus and newborn and has been a major impetus for change in obstetric practices. The Apgar score has been used as a predictive index for neonatal mortality and morbidity and for later neurologic or developmental disability. Both the one- and five-minute scores are predictors of mortality in normal-birthweight infants, whereas in high-risk low-birthweight infants their score is limited. The score is an insensitive predictive index of long-term neurologic or mental handicap, and lacks both sensitivity and specificity to reflect accurately the degree of acidosis. It can be used effectively, however, if these limitations are understood and considered.

Apgar Score↗

PubMed1975

Relationship of Apgar scores and Bayley mental and motor scores.

Infants with 0-3 Apgar scores at 1 minute had significantly lower 8-month mental and motor scores than infants with 7-10 scores and significantly lower mental but not motor scores than infants with 4-6 Apgar scores. Correlations indicated significant relationships (independent of birth weight) between Apgar scores and Bayley mental and motor scores for random, Colored Portuguese, and total samples but not for Negroes and whites. Results demonstrated a significant difference in Apgar scores by 8-month classifications with significantly lower scores for children classified as abnormal, and by longevity with significantly lower scores for neonates who died within 2 days.

Apgar Score↗

PubMed1990

Mortality and immediate morbidity in term babies with low Apgar scores (Zimbabwe).

A retrospective study was undertaken to document immediate morbidity and mortality associated with low Apgar scores (5 or less) at 5 min in singleton term babies (37 weeks or more). From October 1986 to February 1987, 84 term babies had low Apgar scores, giving an incidence of 15/1000 live births. Overall mortality in these patients was 42%, and in those in whom Apgar scores remained 0-3 at 5 min, mortality was 77%. Evidence of severe-to-moderate hypoxic-ischaemic encephalopathy was noted in 44 (52%) and 17 (20%) failed to establish spontaneous respiration within the 1st few hours of life. Meconium aspiration syndrome was diagnosed in 29 (35%). A control group of 141 term babies with 5-min Apgar scores of 7 or more were identified and the presence of possible risk factors associated with low Apgar scores was assessed. Primiparity and prolonged second stages of labour in all parities were found to be significantly associated with low Apgar scores. Improved obstetric care and appropriate management of the newborn at delivery and in the neonatal period may help to reduce mortality and morbidity in some term babies.

Adult↗

PubMed1991

[The study of Apgar score and infant birth weight in the central Taiwan].

The objective of this study was to assess the relationship between birth weight and the Apgar Score. We collected data on the birth weights and the 1 min and 5 min Apgar Score of new born infants between 1982 and 1987 at a teaching hospital in Central Taiwan. Compared to babies with normal Apgar Score, infants with low Apgar Scores were found to born with low and very low birth weights. In the 1 min of life test, the relative risks of low birth weights among infants with Apgar Scores of 0 to 3 and 4 to 6 were 115.0 and 5.9 times higher than those of normal infants, respectively. In the very low birth weight category, the relative risks of the above score were 252.5 and 51.1, in this order. In the 5 min of life test, the relative risks of the above scores were 16.2 and 12.1 in the low birth weight category, respectively. However, among babies of very low birth weight, the relative risks of the same scores were 121.2 and 84.9, in this order. In conclusion, the 5 min Apgar Score might be a useful prognostic index for the relationship between health and birth weight of new born infants.

Apgar Score↗

PubMed1977

Correlation of biochemical data with Apgar scores at birth and at one minute.

A prospective study of 66 unselected neonates revealed a better correlation of umbilical artery blood biochemical data with the Apgar score at birth compared with the score at 1 min. The data confirmed also that inclusion of the score for "colour" detracts from the value of the total score. An Apgar score at birth is more valuable than the score at 1 min.

Apgar Score↗

PubMed1975

[Has the pH meter replaced the Apgar score?].

The introduction of measuring the pH appears to place it in competition with Apgar scoring because of its precision. A study of this which has been carried out has illustrated that there are two different criteria for assessing the state of the infant at birth. The usual agreement between pH values and Apgar scoring can be broken when clinical fetal distress has become established before metabolic equilibrium of the infant has become modified. In these circumstances the Apgar score will be bad while the pH will be good.

Apgar Score↗

PubMed1976

"Prediction" of the one-minute Apgar score from fetal heart rate data.

The value of any fetal monitoring technic is in its ability to predict infant outcome. In the present study, the ability of fetal heart rate (FHR) monitoring data to "predict" a measure of short-term infant outcome, the 1-minute Apgar score, was evaluated using univariate and multivariate statistical analyses. Of 61 monitored high-risk infants, 46 had high (7 to 10) and 15 had low (1 to 6) 1-minute Apgar scores. Computer analysis of FHR/intrauterine pressure (IUP) data for these 61 infants revealed that the infants with low Apgar scores had more than the expected number of late decelerations (LD). Using a threshold of ten LD and univariate analysis, 74% of the infants could be properly classified for high or low Apgar scores, but 60% of the infants with low Apgar scores were not identified. Using discriminant function (multivariate) analysis for the numbers of LD and uterine contractions, 47% of the depressed infants were appropriately identified and simple risk scoring equations were devised. Using additional observation vectors, including the number of accelerations and early decelerations, 67% of the depressed infants could be identified. The results of this study suggest that using multiple observation vectors improves the predictive capacity and, thus, the value of fetal monitoring data. Clinical experience suggests that the value of monitoring data can be further enhanced by simultaneous evaluation of other observation vectors from additional perinatal data sets using the technics of this study.

Analysis of Variance↗

PubMedDate not supplied

Correlation of ominous fetal heart rate pattern and scalp blood pH with one-minute Apgar score.

Fetal minitoring data were analyzed in 176 labors that developed ominous fetal heart rate deceleration patterns (FHRDP) during the two hours prior to delivery in an effort to identify how neonatal condition could be most accurately predicted. It was found that ominous FHRDP corresponded to a one-minute Apgar score of 6 or less in only 15.3% of cases. When patterns with fetal scalp blood pHs (FSBpH) of less than or equal to 7.20 (n = 18) were considered, 44.4% had an Apgar score of 6 or less. Mean Apgar scores for those neonates who had a pH of less than or equal to 7.20 were significantly less than the mean Apgar score of the control group (p less than 0.001 for all deceleration types). The result reveals that FSBpH has a better predictive value than FHRDP alone for neonatal depression. It is suggested that, as soon as ominous FHRDP occurs during labor, FSBpH be performed to assess not only fetal status but also to predict neonatal outcome.

Apgar Score↗

PubMed1978

Child abuse. Its relationship to birthweight, apgar score, and developmental testing.

Fifty-two abused and 23 nonabused children from a low socioeconomic group were studied with respect to birthweight, five-minute Apgar score, and developmental quotients. An association was found between low Apgar scores, low birthweight, poor performance on developmental testing, and child abuse. Furthermore, it was found that among children with normal birthweights, abused children tended to have lower Apgar scores and significantly lower developmental quotients. This study suggests that among this group of children, abuse and subsequent poor performance may be related not only to the socioeconomic status of the children but also to the characteristics the child brings to the parent-child relationship and to the abusive environment.

Apgar Score↗

PubMed1977

Respiratory depression at birth--value of Apgar score and ventilatory measurements in its detection.

The purpose of this investigation was to determine the value of ventilatory measurements and Apgar score in the diagnosis of respiratory depression in the newborn infant. The following were the results of the determinations made in 24 neonates whose mothers had received meperidine in a total dose up to 3 mg/kg within three hours prior to delivery; Respiratory rate, 51+/-3.7/minute; tidal volume, 21.4 +/- 1.5 ml; minute ventilation, 339 +/- 24 ml/kg X minute; end tidal CO2, 40.8 +/- 1.3 mm Hg; ventilatory response to CO2, 21.8 +/- 2.7 ML/KG X minute X mm Hg PACO2. The mean Apgar score was 7.1 and 9.0 at 1 and 5 minutes, respectively. None of the determinations were indicative of respiratory depression with the exception of the slope of the CO2 response curve; it was considered to be below the normal range. No correlations existed between the CO2 response curve and any other values. It is concluded that meperidine administered to mothers in labor in the described dose will not significantly alter Apgar score, VE, VT, RR, AND PAco2 in the newborn infant. The extent of respiratory center depression could be determined only by the decreased ventilatory response to CO2.

Apgar Score↗

PubMed1991

Association between umbilical artery cord pH, five-minute Apgar scores and neonatal outcome.

A prospective study was conducted of 270 intrapartum patients admitted in labor to investigate the independent and combined relationships between umbilical arterial cord pH and Apgar scores and neonatal outcome. The results revealed that when assessed independently, a low 5-min Apgar score (less than 7) was associated with both NICU admission and neonatal sepsis. When categorized by both cord pH and 5-min Apgar, the majority of patients (75.9%) had both parameters normal, 20.7% had an abnormal pH (less than 7.20) and normal Apgar (greater than or equal to 7) and few patients had either both normal or an abnormal Apgar given a normal pH. Given a normal 5-min Apgar score, additional information about the cord pH did not enhance the predictability for either NICU admission or neonatal sepsis. Neonates with both an abnormal pH and 5-min Apgar had the highest incidence of NICU admission. For all neonates, the presence of meconium greatly increased the likelihood of being admitted to the NICU.

Acidosis↗

PubMed1979

[Investigation on the influence of a tocolytic treatment of pregnant women with diazepam and fenoterol on the bilirubin levels and apgar score of newborn (author's transl)].

In a retrospective study of 2618 pregnant women we examined the influence of diazepam monotherapy as well as the combination of diazepam and fenoterol on the bilirubin concentrations and Apgar scores of the newborn children. In the diazepam-treated group 17-27% of the newborns showed Apgar scores of 6 or less. In the group treated with diazepam and fenoterol, 66-68% of the newborn had Apgar scores of 6 or less. The effect of diazepam on the bilirubin levels appears to depend on the dose and duration of the diazepam treatment: low, short term diazepam doses cause a slight bilirubin increase, while higher diazepam doses cause a reduction of the bilirubin levels. Following the combination therapy of diazepam and fenoterol a significant number of the infants developed neonatal jaundice. Due to the fact that following the combination therapy the diazepam concentration of the newborns were higher than following the monotherapy, we ascribe the greater frequency of the low Apgar values and also possibly the larger bilirubin increase to the higher diazepam concentration caused by fenoterol.

Apgar Score↗

PubMed1992

Methods of resuscitation in low-Apgar-score newborn infants--a national survey.

The incidence, treatment and immediate course in infants with postnatal apnoea were studied. Information on all infants born in Sweden in 1985 with a low Apgar score (3 or less at 1 min or 6 or less at 5 min) was collected from the midwife and from the baby's chart. Of the 97,648 live births, 1633 (1.7%) had a low Apgar score. The risk increased with decreasing birthweight and with severe malformations. Before delivery, 19% of the low-Apgar-score infants were not expected to require resuscitation. Eighty percent of the ventilated infants were satisfactorily ventilated by bag and mask; the remainder were intubated. Of the ventilated infants, 78% developed spontaneous breathing within 10 min after birth and 89% within 20 min. Routine intubation or administration of buffer in cases of postnatal asphyxia had no influence on the time to onset of regular spontaneous breathing.

Apgar Score↗

PubMedDate not supplied

Predicting infant apgar scores.

This study identified psychologic and sociologic phenomena that affect a woman during pregnancy which, when associated with physical factors, result in poor neonatal outcome for the infant, as measured by the Apgar score at five minutes after birth. The Utah Test Appraising Health (UTAH) was administered to 51 pregnant women during the second or third trimester of pregnancy. Data measuring maternal and infant outcomes were collected postdelivery. A significant correlation was found between maternal stress up to six months before administration of the UTAH questionnaire and the five-minute infant Apgar score (r = -.2787, p less than or equal to .05). The stress score was combined with past pregnancy complications, pregnancy symptoms during the first and third trimesters, and illness-proneness in a regression equation. The total multiple correlation coefficient was .8979, with stress X past pregnancy complications contributing most to the prediction equation. When stress and past pregnancy complications were controlled, the partial correlation value was -.8001. The data were consistent with the hypothesis that stress during pregnancy is an activator of physical illness processes in the mother, and, when combined with these variables, is related to neonatal outcome, as measured by the infant Apgar score at five minutes.

Adaptation, Psychological↗

PubMed1978

Correlation between foetal pH, cord blood glucose level and Apgar score in a foetal intensive care unit--preliminary report.

The foetal pH (the term 'foetal pH' is used for the pH of foetal capillary blood obtained by making a small incision in the foetal scalp or buttocks) and the umbilical cord blood glucose levels in pregnant women with foetal distress were estimated in 19 babies as a prospective study in Ile-Ife, Nigeria. The Apgar Scores on delivery were also estimated. There was a significant correlation coefficient between foetal pH and Apgar Score r = 0.38 and the coefficient of correlation between umbilical artery blood glucose and foetal pH was 0.08. Estimation of the pH of blood taken from the foetal scalp is now well established as a diagnostic measure in the early diagnosis of foetal distress due to hypoxia. The results obtained from this small series of nineteen patients highlights the importance of the estimation of foetal pH, blood glucose and the Apgar Score. This is the first account in Ile-Ife, Nigeria.

Apgar Score↗

PubMed1979

Underlying disorders responsible for the neonatal deaths associated with low Apgar Scores.

Data from a large study were used to determine the frequency of fatal disorders associated with low Apgar scores. 5-min scores had the best correlation with mortality rates. Death rates were more than ten times greater with abnormal than with normal 5-min scores. This difference was only 3-fold for 1-min values. Amniotic fluid infections were responsible for nearly half of the deaths in preterm and 24% of the deaths in term neonates with 5-min Apgar scores 0--6. The respective values for disorders that cause antenatal hypoxia were 25 and 24% and for major congenital anomalies, 7 and 28%.

Abruptio Placentae↗