Correlation of Apgar Score with Asphyxial Hepatic Injury and Mortality in Newborns: A Prospective Observational Study from India

Abstract

OBJECTIVEThe objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns.MATERIAL AND METHODSThis is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured on postnatal days 1, 3, and 10 in the study and control groups. Neonatal mortality was observed in the study and control population.RESULTSCorrelation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for deranged hepatic function showed significant correlation (odds ratio [OR] 4.88, 95% CI 3.26–5.84, P = 0.01 and OR 2.46, 95% CI 1.94–3.32, P = 0.02, respectively). There was a significant increase in serum lactate dehydrogenase (LDH) and total bilirubin on day 1 and serum LDH at age of 10th postnatal life in severely asphyxiated neonates when compared to moderately asphyxiated neonates, whereas there was a significant decrease in total bilirubin and serum albumin on day 3 in severely asphyxiated neonates. There was a significant increase in serum alanine transaminase, serum LDH, and total bilirubin on day 1, serum aspartate transaminase, serum LDH, and total bilirubin on day 3, and International Normalized Ratio on day 10 of postnatal life when severely asphyxiated neonates were compared with normal neonates. There was a significant reduction in total protein and serum albumin on day 1 and direct bilirubin on day 3 in severely asphyxiated neonates when compared with normal neonates. There was a significant increase in neonatal mortality in severely asphyxiated neonates when compared to the other two groups. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for neonatal mortality showed significant correlation (odds ratio [OR] 2.23, 95% CI 1.42–3.04, P = 0.03 and OR 1.87, 95% CI 1.64–2.02, P = 0.04, respectively).CONCLUSIONThe severity of hepatic dysfunction correlates well with increasing severity of asphyxia. The neonatal mortality also showed good correlation with Apgar score in our study, although we need a large multicentric trial to confirm our observations. Apgar score combined with hepatic dysfunction can be used as a prognostication marker for neonatal mortality.

Severe Perinatal Asphyxia and Risk of Neonatal Jaundice at a Tertiary Hospital in Northern Nigeria

“…However, a few surveys have looked at the effects of SPA on serum bilirubin with inconsistent results. While some reports have indicated that SPA is associated with a low risk of hyperbilirubinaemia, [2,3,[10][11][12] others have postulated that SPA is often accompanied with a rise in serum bilirubin [4,13,14]. Our findings are more correlated to the former.…”

Using lactate dehydrogenase to predict the severity of respiratory distress in term newborn infants with no perinatal asphyxia

“…A low 5-minute Apgar score alone was correlated to elevated LDH. 10 The negative predictive value of the 5-minute Apgar score is the more reliable indicator; wherein a score of 7 or greater, "it is unlikely" that peripartum hypoxia would cause neonatal encephalopathy. 11 The mean 5-minute Apgar score for our cohort was 8.7.…”

“…Studies on perinatal asphyxia with or without HIE consistently show that the LDH in newborns with moderate and severe asphyxia peaks on day 3 after which it gradually decreases, normalizing within 10 days of life. 2,10,17 In mildly asphyxiated newborns, the elevated day 1 LDH decreased by day 3. 10,17 Thus, persistently raised and increasing LDH levels on day 3 in both our respiratory distress groups would be explained by perinatal asphyxia only if it was moderate or severe; however, we had no demonstrable perinatal asphyxia.…”

“…2,10,17 In mildly asphyxiated newborns, the elevated day 1 LDH decreased by day 3. 10,17 Thus, persistently raised and increasing LDH levels on day 3 in both our respiratory distress groups would be explained by perinatal asphyxia only if it was moderate or severe; however, we had no demonstrable perinatal asphyxia. Therefore, our increasing LDH levels would most likely be due to the respiratory conditions themselves: presumably secondary to associated lung cellular injury, peripheral organ effects associated with the respiratory conditions, or possibly even by cellular injury caused by the administered respiratory support.…”

The Effect of Asphyxia on Neonatal Death: A Meta-Analysis

“…According to a study conducted by Seikku et al (2016), low APGAR score at the fifth and tenth minutes of birth reflected asphyxia which could predict neonatal mortality. Another study conducted by Sharma et al (2012) found that low APGAR score in neonates had a 2.23 times risk of having neonatal death compared to neonates with high APGAR score. The low APGAR score reflected the level of service availability and service standards that were not appropriate during delivery (Berglund et al, 2010).…”