Comparison of Combined Apgar Score and Umbilical Cord Arterial Blood Gas in Prediction of Poor Short Term Outcomes in Neonates

Document Type : Original Article

Authors

1 Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

2 Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran

3 Health Research Institute, Babol University of Medical Sciences, Babol, Iran

Abstract

Background: The APGAR scoring system, including conventional, expanded, and combined Apgar scores, has been used to evaluate the condition of the newborn in the first minutes of birth. Umbilical cord arterial blood gas analysis (UCABGA) is another method. We compared the combined Apgar score with UCABGA in predicting short-term outcomes in neonates.
Methods: A prospective cohort study was conducted on 363 live births. Neonates with major congenital anomalies, congenital cyanotic heart disease, congenital metabolic disorders, and those who transferred to other hospitals were excluded. Admission, discharge, demographic data, and Apgar scores were recorded in a pre-designed form. After delivery, the umbilical cord was double-clamped, and an arterial blood sample was taken from the clamped part. Statistical analyses were done using SPSS version 22 statistical software, and the receiver operating characteristic (ROC) curve was used to analyze the correlations between variables.
Results: Out of 350 Neonates (204 male and 146 female) with a mean gestational age of 33.37±4.12 weeks, 263 (75.1%) neonates were admitted, and 34 neonates (9.7%) died. Retinopathy of prematurity(ROP) and Intraventricular hemorrhage (IVH) were recognized in 42 (12%) and 54 (15.4%) neonates, respectively, and 37 ( 10.6%) neonates ventilated mechanically. ROC curves show higher sensitivity and Specificity of 5th minute Combined Apgar score than PH and base deficit in predicting short-term outcomes except for IVH.
Conclusion: The Combined Apgar score at minute 5 is a better predictor than UCABGA in predicting Death, need for admission, retinopathy of prematurity, and need for mechanical ventilation. None are good predictors for IVH.
 

Keywords

References

  1. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32(4):260-267.
  2. American Academy of Pediatrics. American college of obstetricians and gynecologists; Committee on obstetric practice. The apgar score. Adv Neonatal Care. 2006;6:220-223.
  3. Rüdiger M, Aguar M. Newborn assessment in the delivery room. Neoreviews. 2012;13(6):e336-e342.
  4. Rüdiger M, Braun N, Aranda J, Aguar M, Bergert R, Bystricka A, et al. Neonatal assessment in the delivery room–trial to evaluate a specified type of apgar (TEST-Apgar). BMC pediatrics. 2015;15(1):18.
  5. Lee JH, Jung J, Park H, Kim S-y, Choi S-J, Oh S-y, et al. Umbilical cord arterial blood gas analysis in term singleton pregnancies: a retrospective analysis over 11 years. Obstet Gynecol Sci. 2020;63(3):293-304.
  6. Ferreira CS, Melo Â, Fachada AH, Solheiro H, Martins NN. Umbilical cord blood gas analysis, obstetric performance and perinatal outcome. Rev Bras Ginecol Obstet. 2018;40(12):740-748.
  7. Ruth VJ, Raivio KO. Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score. BMJ. 1988;297(6640):24-27.
  8. ACoOa G. Executive summary: neonatal encephalopathy and neurologic outcome. Obstetrics & Gynecology. 2014;123(4):896-901.
  9. Armstrong L, Stenson BJ. Use of umbilical cord blood gas analysis in the assessment of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92(6):F430-434.
  10. Fee SC, Malee K, Deddish R, Minogue JP, Socol ML. Severe acidosis and subsequent neurologic status. Am J Obstet Gynecol. 1990;162(3):802-806.
  11. Lavrijsen SW, Uiterwaal CS, Stigter RH, de Vries LS, Visser GH, Groenendaal F. Severe umbilical cord acidemia and neurological outcome in preterm and full-term neonates. Biol Neonate. 2005;88(1):27-34.
  12. Hafström M, Ehnberg S, Blad S, Norén H, Renman C, Rosén KG, et al. Developmental outcome at 6.5 years after acidosis in term newborns: a population-based study. Pediatrics. 2012;129(6):e1501-1507.
  13. Mlodawska M, Mlodawski J. Relationship between Apgar score and umbilical cord blood acid-base balance in full-term and late preterm newborns born in medium and severe conditions. Ginekol Pol. 2021.
  14. Ghimire A, Shrestha L, Shrestha M. Analysis of umbilical cord blood gas in term and near term asphyxiated newborn babies. JPAHS. 2017;4(2):3-8.
  15. Ahmadpour-Kacho M, Asnafi N, Javadian M, Hajiahmadi M, Taleghani N. Correlation between umbilical cord pH and Apgar score in high-risk pregnancy. Iran J Pediatr. 2010;20(4):401-406.

 

Iranian Journal of Neonatology
Volume 15, Issue 3
July 2024
Pages 49-54

Files

Share

How to cite

Statistics