Apgar Score and Neonatal Mortality. the Collaborative Neonatal Health Study Group (Neosano)'s Experience in Mexico. Looking Through the Eyes of Virginia
Erika Galvan-Bautista, Monica Villa-Guillen, Maria Teresa Murguia-de Sierra, Grupo Neosano. Neonatology, Hospital Infantil de México Federico Gómez, Mexico City, DF, Mexico; Neonatal Health Study Group, Mexico.
BACKGROUND: In Mexico, birth asphyxia is the second most common cause of neonatal mortality. Measurement of pH in umbilical-artery blood is not always feasible. The Apgar score is a useful, universally available tool to predict neonatal mortality.
OBJECTIVE: 1. To determine incidence and risk factors (RF) for 5-minute (min) Apgar score ≤3 in the study population and its role as predictor for neonatal mortality.
DESIGN/METHODS: Setting: 8 hospitals in Mexico. Study period: Jan 2001-June 2004. Prospectively, a questionnnaire was filled out for each delivery. Infants were followed-up until discharge. Subjects: All live births with an available 5-min Apgar score. Main outcomes: Adjusted odds ratios (OR), relative risks (RR), 95% confidence intervals (CI) and attributable risk percentages (AR) for incidence of 5-min Apgar score ≤3 and related deaths. p <0.05 was significant.
RESULTS: Apgar scores at 5 min were available for 27,227 live births; of these, 2887 (10.6%) were preterm (PT). Overall, neonatal mortality was 15.5/1000 live births. There were 59 babies with 5-min Apgar scores ≤3 (incidence 2.16/1000 live births); of these, 43 (73%) died (1.58/1000 live births). For PT infants, the neonatal mortality rate was 946/1000 for babies with 5-min Apgar scores ≤3, as compared with 76.3/1000 for infants with 5-min Apgar scores >6 (RR; 95%CI:12.4;10.6-14.4). For 24,230 term infants, the mortality rate was 364/1000 for infants with 5-min Apgar score ≤3, as compared to 2.64/1000 for infants with 5-min Apgar scores >6 (RR;95% CI:138;75-252). RF significantly associated to 5-min Apgar score ≤3 (OR; AR%) were: oligo/polyhydramnios (10.3;3.6), maternal education <9 years (12.8; 47.6), and birth weight (g) 1500-2499 (4.2; 25.7), 1000-1499 (23.4; 18.3), 800-999 (144.2; 22.2) and <800 (2986; 85.6).
CONCLUSIONS: A 5-min Apgar score ≤3 was present in 2.16/1000 live births and represented 10% of neonatal deaths in our study population. It was a better predictor of mortality in term, as compared to PT infants; this may be explained by the gestational age effect on Apgar score and the very high mortality rate observed in all PT infants. RF associated to 5-min Apgar scores ≤3 were related to low maternal education, oligo/polyhydramnios and low birthweight.
First Author is a Fellow in Training
PAS 2005: 57: 2415
Tuesday, May 17, 2005 11:45 am, Washington Convention Center - Room 207 A
Platform Session: Global Perspectives on Birth Asphyxia, Part II (10:30 AM - 12:30 PM)
Course Number: 7350