The Backgrounds and Outcomes of the Term Infants with Low 5-Minute Apgar Scores Admitting to NICU: The Neonatal Mutual Cooperative System Network in Osaka, Japan, 1980-2000
Hidehiko Nakanishi, Hirokuni Negishi, Masanori Fujimura. Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan; Neonatal Mutual Cooperative System Osaka, Osaka, Japan.
BACKGROUND: Low 5-minute Apgar score is not alwaws a specific indicator of birth asphyxia, but usually implies complications of clinical importance, indicating that the newborn has not responded optimally to resuscitation.
OBJECTIVE: The purpose of this study is to determine the rate of 5-minute Apgar scores below 7 in term infants (above 36 weeks) admitting to the NICU of the Neonatal Mutual Cooperative System (NMCS) of Kansai area, Japan during 21 years (1980-2000), look for time trends, evaluate the influence of obstetric risk factors on low 5-minute Apgar scores, and to study the infant prognosis regarding infant mortality and neurologic morbidity
DESIGN/METHODS: We analyzed data of newborn infants admitted to NICUs of the NMCS Network for the last 21 years (1980-2000). During this period, a total of 44,514 newborns were registered to the NMCS database. 20,695 infants (46.5%) were analyzed excluding those infants born before 37 completed weeks, or with unknown gestational age, with unknown Apgar score, or with severe malformations likely to affect Apgar score. Odds ratios (OR) and confidence intervals (CI) were calculated.
RESULTS: Among 20,695 term newborns, 1,252 (6.0%) had 5-minute Apgar scores below 7. The annual rate of low Apgar score did not change as a whole. The rate of low Apgar score in outborn gradually increased from 3.8% in 1980 to 7.2% in 2000. The high OR was found for over 42 weeks gestational age (OR 2.1), birth weight less than 1500g (OR 2.2), body weight standard deviation over 3.0 (OR 2.1), forceps delivery (OR 1.7), abnormal presentation (OR 1.8). The infant mortality rate with low Apgar score was 13% (OR 8.0) and the ORs were 6.8 for a group with convulsion and 7.0 for cerebral palsy. Outborn infants (OR 1.6), low body temperature under 35.5 degrees centigrade on admission (OR 2.3), renal failure (OR 3.8), and DIC (OR 8.6) increased the risk for death.
CONCLUSIONS: Several obstetric risk factors were associated with low 5-minute Apgar score in term infants. Mortality and the risk of severe neurologic morbidity increased in these infants. Outborn infants had a higher incidence of low 5-minute Apgar score, and this group requires the strategy for better care to improve the overall outcome
First Author is a Fellow in Training
PAS 2005: 57: 2416
Tuesday, May 17, 2005 12:00 pm, Washington Convention Center - Room 207 A
Platform Session: Global Perspectives on Birth Asphyxia, Part II (10:30 AM - 12:30 PM)
Course Number: 7350