The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered as evidence of, or a consequence of, asphyxia; does not predict individual neonatal mortality or neurologic outcome; and should not be used for that purpose. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists encourage use of an expanded Apgar score reporting form that accounts for concurrent resuscitative interventions. INTRODUCTIONIn 1952, Dr Virginia Apgar devised a scoring system that was a rapid method of assessing the clinical status of the newborn infant at 1 minute of age and the need for prompt intervention to establish breathing. 1 Dr Apgar subsequently published a second report that included a larger number of patients. 2 This scoring system provided a standardized assessment for infants after delivery. The Apgar score comprises 5 components: (1) color; (2) heart rate; (3) reflexes; (4) muscle tone; and (5) respiration. Each of these components is given a score of 0, 1, or 2. Thus, the Apgar score quantitates clinical signs of neonatal depression, such as cyanosis or pallor, bradycardia, depressed reflex response to stimulation, hypotonia, and apnea or gasping respirations. The score is reported at 1 minute and 5 minutes after birth for all infants, and at 5-minute intervals thereafter until 20 minutes for infants with a score less than 7. 3 The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if it is needed; however, it has been inappropriately used to predict individual adverse neurologic outcome. of Obstetricians and Gynecologists in collaboration with the American Academy of Pediatrics, along with new guidance on neonatal resuscitation. The guidelines of the Neonatal Resuscitation Program state that the Apgar score is useful for conveying information about the newborn infant's overall status and response to resuscitation. However, resuscitation must be initiated before the 1-minute score is assigned. Therefore, the Apgar score is not used to determine the need for initial resuscitation, what resuscitation steps are necessary, or when to use them. 3 An Apgar score that remains 0 beyond 10 minutes of age may, however, be useful in determining whether continued resuscitative efforts are indicated because very few infants with an Apgar score of 0 at 10 minutes have been reported to survive with a normal neurologic outcome. 3,5,6 In line with this outcome, the 2011 Neonatal Resuscitation Program guidelines state that "if you can confirm that no heart rate has been detectable for at least 10 minutes, discontinuation of resuscitative efforts may be appropriate." 3The Neonatal Encephalopathy and Neurologic Outco...
ExtractMidtricipital (MT) and subscapular (SS) skinfolds were measured within 24 hr of birth in 23 normally grown mature (NG-M) ; 23 normally grown premature (NG-P) ; 6 intrauterine growth-retarded mature (IGR-M); and 7 intrauterine growth-retarded premature (IGR-P) infants. A rapid initial decrease in measured skinfold thickness (SFT) occurred after application of a Harpenden caliper, but readings stabilized by 60 s (SFTGO). Measurements were recorded at 15 and 60 s. The difference between 15-and 60-s readings was expressed in percentage of the 15-s reading (percentage ASFT) .The amount of subcutaneous fat, estimated from the SFTGO measurements, was affected by duration of gestation in the NG-M and NG-P and the IGR-M and IGR-P groups. In both NG groups, good linear correlations with birth weight (r = 0.852 at M T and 0.874 at SS, P < 0.001) and with gestational age (r = 0.842 at M T and r = 0.804 at SS, p < 0.001) were evident. Values for intrauterine growth-retarded infants deviated markedly from the mean SFTGO expected for their gestational age.Percentage ASFT was affected by duration of maturation but not by impaired intrauterine growth. I t correlated with gestational age (r = -0.777 at MT and -0.773 at SS, P < 0.001) and with maximal postnatal weight loss (r = 0.579 at M T and 0.553 at SS, P < 0.001) in all groups and with birth weight in the premature groups only (r = -0.479 at M T and -0.520 at SS, P < 0.01). The similarity of these trends with those of direct extracellular water measurements suggested that percentage ASFT may be an estimate of subcutaneous interstitial water. SpeculationChanges in body composition during fetal life include fat deposition in the subcutaneous and internal body stores and a decrease in the proportion of body weight occupied by water. Intrauterine growth retardation results in lower fat stores and expansion of all body water compartments. The present data suggest that skinfold thickness recorded 60 s after caliper application and the difference between the 15-and 60-s readings provide estimates of fat stores and subcutaneous interstitial water, respectively. Caliper skinfold measurements can therefore be used for noninvasive studies of perinatal body composition and nutrition.
This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks' gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.
A method was developed for assessing indirectly the fecal excretion of carbohydrate-derived energy. Then, eight healthy premature infants (28 to 32 wk gestation, postnatal age 12 to 30 days) were randomly assigned to receive one of two formulas that differed only in the carbohydrate source: 100% lactose or 50% lactose: 50% glucose polymer (lactose + glucose polymer). Excreta collections were analyzed for total nitrogen, urea nitrogen, ammonia, fat, and total energy. Carbohydrate energy absorption was calculated. The formulas were well tolerated and stool frequency, energy intake, weight gain, and nitrogen balance were not different in the two formula groups. Also, there were no significant intergroup (lactose versus lactose + glucose polymer) differences in the coefficients (%) (x +/- SD) of fat absorption (90 +/- 6 versus 93 +/- 5) or carbohydrate energy absorption (96 +/- 1 versus 95 +/- 3). Thus, net carbohydrate-energy absorption appeared normal in these premature infants who showed no clinical formula intolerance.
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