Vol 94, No 2 (2023)
Research paper
Published online: 2022-06-03

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Use of the expanded Apgar score for the assessment of intraventricular and intraparenchymal haemorrhage risk in neonates

Agnieszka Goralska1, Joanna E. Puskarz-Gasowska1, Pawel Bujnowski2, Renata Bokiniec1
Pubmed: 35894485
Ginekol Pol 2023;94(2):146-151.

Abstract

Objectives: Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates.
Material and methods: Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw.
Results: Gestational age was the most relevant discriminating variable for the prediction of intraventricular III degree and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score ≤ 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively.
Conclusions: Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS.

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References

  1. Committee on Obstetric Practice American Academy of Pediatrics—Committee on Fetus and Newborn. Committee Opinion No. 644. The Apgar Score. Obstetrics & Gynecology. 2015; 126(4): e52–e55.
  2. American Academy of Pediatrics, Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists and Committee on Obstetric Practice. The Apgar score. Pediatrics. 2006; 117(4): 1444–1447.
  3. Montgomery KS. Apgar Scores: Examining the Long-term Significance. J Perinat Educ. 2000; 9(3): 5–9.
  4. Hogan L, Ingemarsson I, Thorngren-Jerneck K, et al. How often is a low 5-min Apgar score in term newborns due to asphyxia? Eur J Obstet Gynecol Reprod Biol. 2007; 130(2): 169–175.
  5. Lee HC, Subeh M, Gould JB. Low Apgar score and mortality in extremely preterm neonates born in the United States. Acta Paediatr. 2010; 99(12): 1785–1789.
  6. Jain L, Ferre C, Vidyasagar D, et al. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome. J Pediatr. 1991; 118(5): 778–782.
  7. , et alAmerican College of Obstetrics and Gynecology. Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology. Washington, DC ACOG. 2003.
  8. Carter BM, Holditch-Davis D. Risk factors for necrotizing enterocolitis in preterm infants: how race, gender, and health status contribute. Adv Neonatal Care. 2008; 8(5): 285–290.
  9. Chua CO, Vinukonda G, Hu F, et al. Effect of hyperoxic resuscitation on propensity of germinal matrix haemorrhage and cerebral injury. Neuropathol Appl Neurobiol. 2010; 36(5): 448–458.
  10. Sánchez-Torres AM, García-Alix A, Cabañas F, et al. Impacto de la reanimación cardiopulmonar avanzada en recién nacidos pretérmino de extremado bajo peso [Impact of cardiopulmonary resuscitation on extremely low birth weight infants]. An Pediatr (Barc). 2007; 66: 38–44.
  11. Szpecht D, Frydryszak D, Miszczyk N, et al. The incidence of severe intraventricular hemorrhage based on retrospective analysis of 35939 full-term newborns-report of two cases and review of literature. Childs Nerv Syst. 2016; 32(12): 2447–2451.
  12. Bokiniec R. Odległe skutki krwawień do ośrodkowego układu nerwowego u noworodków Pediatr Dypl. 2013; 17: 2–6.
  13. Rüdiger M, Braun N, Aranda J, et al. TEST-Apgar Study-Group. Neonatal assessment in the delivery room--Trial to Evaluate a Specified Type of Apgar (TEST-Apgar). BMC Pediatr. 2015; 15: 18.
  14. Rüdiger M, Aguar M. Newborn Assessment in the Delivery Room. NeoReviews. 2012; 13(6): e336–e342.
  15. Dalili H, Nili F, Sheikh M, et al. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PLoS One. 2015; 10(3): e0122116.
  16. Committee on Obstetric Practice, ACOG, American Academy of Pediatrics; Committee on Fetus and Newborn, ACOG. ACOG Committee Opinion. Number 333, May 2006 (replaces No. 174, July 1996): The Apgar score. Obstet Gynecol. 2006; 107(5): 1209–1212.
  17. Dalili H, Sheikh M, Hardani AK, et al. Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes. PLoS One. 2016; 11(2): e0149464.
  18. Fahey J, King TL. Intrauterine asphyxia: clinical implications for providers of intrapartum care. J Midwifery Womens Health. 2005; 50(6): 498–506.
  19. Is the Apgar score outmoded? Lancet. 1989; 1(8638): 591–592.
  20. Marlow N. Do we need an Apgar score? Arch Dis Child. 1992; 67(7 Spec No): 765–767.
  21. Behnke M, Eyler FD, Carter RL, et al. Predictive value of Apgar scores for developmental outcome in premature infants. Am J Perinatol. 1989; 6(1): 18–21.
  22. Socol ML, Garcia PM, Riter S. Depressed Apgar scores, acid-base status, and neurologic outcome. Am J Obstet Gynecol. 1994; 170(4): 990–998.
  23. Padayachee NBD. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. South African Journal of Child Health. 2013; 7: 89–94.
  24. Shah P, Riphagen S, Beyene J, et al. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004; 89(2): F152–F155.
  25. Shah PS, Perlman M. Time courses of intrapartum asphyxia: neonatal characteristics and outcomes. Am J Perinatol. 2009; 26(1): 39–44.