Acidemia in neonates with a 5-minute Apgar score of 7 or greater – What are the outcomes?

Sabol, Bethany; Caughey, Aaron B.

doi:10.1016/j.ajog.2016.05.035

Cited by 75 publications

(85 citation statements)

References 14 publications

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“…Our findings are consistent with other studies which showed that emergency caesarean birth increases the risk of neonatal respiratory distress and other complications including hypoglycemia, sepsis, and admission to NICU compared to normal vaginal delivery [2,18]. Furthermore, there is also evidence to suggest that neonates with acidemia at birth, despite a normal Apgar score, have worse outcomes compared with their non-acidemic counterparts [19].…”

Section: Discussionsupporting

confidence: 82%

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

Thavarajah

Flatley

Kumar

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes. Methods: This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers' Hospital in Brisbane, Australia between January 2007 and December 2015. The five minute score was subdivided in to three categories -low (0-3), intermediate (4-6), and normal (7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group. Results: The study cohort consisted of 39,258 births with a recorded five minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (7) Apgar score, 439 (1.1%) had an intermediate score (4-6) and 114 (0.3%) had a low (0-3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes. Conclusions: Low and intermediate five minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 82%

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

Thavarajah

Flatley

Kumar

2017

The Journal of Maternal-Fetal & Neonatal Medicine

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“…pH is the result of the balance between lactates that tend to decrease pH and BE which tend to compensate [4]. Neonatal acidaemia is correlated with an increased risk of admission in neonatal intensive care unit (NICU), hypoxic ischemic encephalopathy, respiratory distress syndrome (RDS) [5,6], multi-organ disfunction and neonatal exitus [7]. Umbilical cord blood gas analysis is important to evaluate neonatal acidaemia during delivery.…”

Section: Introductionmentioning

confidence: 99%

“…It is not clear if newborns with moderate acidaemia and Apgar score ≥ 7 V must be monitored for development of adverse outcome. Newborns with a good Apgar score have a residual risk of neonatal acidaemia and adverse outcomes [7]. Furthermore, Hermansen at al.…”

Section: Introductionmentioning

confidence: 99%

Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

et al. 2020

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Background: Neonatal acidaemia at birth can increase neonatal morbidity and mortality and it is predictive of neonatal asphyxia. The umbilical blood gas analysis is a valid tool for the evaluation of neonatal acidaemia. However, umbilical cord blood gas analysis is commonly performed in high-risk situations or in the setting of Apgar scores < 7 at 5 min. Methods: A retrospective cohort study was conducted from June to December 2018 at the Department of mother's and child's health, Poliambulanza Foundation Hospital Institute. Inclusion criteria were: full term newborns with body weight appropriate for gestational age, born by vaginal delivery or caesarean section, reassuring Apgar Score > 7 at 5 min, arterial cord blood gas analysis showing pH < 7.4 or BE <-8 mmol/l or lactate > 6 mmol/l. The aim was to evaluate the predictive role of blood gas analysis for respiratory distress syndrome in newborns with reassuring Apgar Score. Results: 352 full term newborns were enrolled. Umbilical cord blood artery pH showed an association with respiratory distress syndrome (χ 2 (1) = 10,084, OR (95% CI): 3,9 × 10 − 4 (2,9 × 10 − 6 -0,048); p < 0,05). ROC curve revealed that the cut-off point of pH was 7.12, with a sensibility and specificity of 68 and 63%, respectively. Conclusions: Umbilical cord blood artery pH < 7.12 at birth is associated to respiratory distress syndrome in newborns. Blood gas analysis is an important instrument to help health care providers during assistance in the delivery room, but also to early identify newborns at high risk for respiratory distress syndrome and better manage the care of these newborns after birth.

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“…Both pH and base excess are measured at the time of delivery by umbilical cord blood gas analysis. As pH and base excess are not independent , both low umbilical artery base excess and low umbilical artery pH have been associated with neonatal morbidity such as meconium aspiration syndrome , neonatal sepsis , neonatal intensive care unit admission and moderate and severe newborn encephalopathy and respiratory complications . Low Apgar scores have been related to a higher risk of long‐term neurodevelopmental impairments, especially when Apgar scores remain low at five and ten minutes .…”

Section: Discussionmentioning

confidence: 99%

“…Low umbilical artery pH has been associated with obstetric complications and adverse neonatal outcomes , hypoxic‐ischaemic encephalopathy , neonatal encephalopathy with seizures and neonatal mortality . However, less is known about the long‐term effects when umbilical artery pH and base excess are low.…”

Section: Introductionmentioning

confidence: 99%

Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood

et al. 2019

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Aim: We sought to evaluate the associations between umbilical artery pH and base excess and neurodevelopmental outcome at four years of age.Methods: This study comprised 84 588 singleton children born alive at term in 2005-2011 in the hospital district of Helsinki and Uusimaa in Finland. Data from the maternity hospital information system were linked to the data from the Medical Birth Register and the Hospital Discharge Register. Neurodevelopmental morbidity included cerebral palsy, epilepsy, intellectual or sensorineural impairment.Results: After adjustment for maternal and perinatal factors, a combination of pH <7.00 and base excess <À16.00 was associated with infant death (adjusted odds ratio 19.97; 95% confidence interval 5.38-74.17). Values of pH 7.00-7.10 were associated with cerebral palsy (adjusted odds ratio 2.40; 95% confidence interval 1.05-5.47). A combination of low five-minute Apgar score and umbilical artery base excess <À16.00 showed the highest positive predictive value (9.1%) for neurodevelopmental impairments. When umbilical artery pH <7.00 was included, a positive predictive value of 25.0% was observed for infant mortality.Conclusion: Low umbilical artery pH and base excess at birth were the poor predictors of long-term neurodevelopmental morbidity in an unselected population. However, these parameters might be useful in assessing the risk of infant mortality.Abbreviations CI, Confidence interval; OR, Odds ratio; SD, Standard deviation.

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Acidemia in neonates with a 5-minute Apgar score of 7 or greater – What are the outcomes?

Cited by 75 publications

References 14 publications

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

Predict respiratory distress syndrome by umbilical cord blood gas analysis in newborns with reassuring Apgar score

Umbilical artery pH and base excess at birth are poor predictors of neurodevelopmental morbidity in early childhood

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