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The association between 5-min Apgar score and mortality disappears after 24 h at the borderline of viability.

ABSTRACT: To quantify the relationship between 5-min Apgar scores and infant mortality for infants at the borderline of viability.Cohort study of 7008 infants 23-25 weeks' gestation using 2002 US National Center for Health Statistics data. Using Cox proportional-hazards models, we quantified the relationship between Apgar score and infant mortality for all infants, and then infants surviving their first 24 h. Models were adjusted for gestational age, birth weight, gender, delivery method, plurality, maternal race, marital status and education.Within one year, 46% of infants died. Of the non-survivors, deaths within 24 h were more common among infants with Apgar scores 0-3 (83%) than among infants with Apgar scores 7-10 (13%). When including all infants and adjusting for potential confounders, each 1-point increase in Apgar score decreased the hazard of mortality by 0.82. However, after excluding infants who died within 24 h, the hazard ratio increased to 0.95; although statistically significant, the practical impact was negated.For 23-25 week gestation infants surviving the first 24 h, the Apgar score loses clinical significance. Clinicians should be aware of the limitations of clinical assessments in the delivery room.

SUBMITTER: Lagatta J

PROVIDER: S-EPMC4547603 | biostudies-literature | 2012 Jun

REPOSITORIES: biostudies-literature

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The association between 5-min Apgar score and mortality disappears after 24 h at the borderline of viability.

Lagatta Joanne J Yan Ke K Hoffmann Raymond R

Acta paediatrica (Oslo, Norway : 1992) 20110518 6

<h4>Aim</h4>To quantify the relationship between 5-min Apgar scores and infant mortality for infants at the borderline of viability.<h4>Methods</h4>Cohort study of 7008 infants 23-25 weeks' gestation using 2002 US National Center for Health Statistics data. Using Cox proportional-hazards models, we quantified the relationship between Apgar score and infant mortality for all infants, and then infants surviving their first 24 h. Models were adjusted for gestational age, birth weight, gender, deliv ...[more]

PMID: 21535125

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Project description:(1) Background: We aimed to study whether a low 5 min Apgar score is associated with pediatric neurological morbidities throughout childhood. (2) Methods: A population-based retrospective cohort study was conducted. The exposed group was defined as offspring with a 5 min Apgar score <7, and the remaining offspring served as the comparison group. The primary outcome was defined as pediatric hospitalizations with any neurological morbidity. Multivariable survival models were used to evaluate the association between the exposure and outcome while adjusting for potential confounders. Additional models were used to study this association separately among term- and preterm-born offspring. (3) Results: The study population included 349,385 singletons born between the years 1991 and 2021, 0.6% (n = 2030) of whom had a 5 min Apgar score <7 (exposed). The cohort was followed for up to 18 years (median ~ 10.6). The incidence of neurological morbidity-related hospitalizations was higher among the exposed group versus the unexposed group (11.3% versus 7.5%, hazard ratio = 1.84; 95%CI 1.58-2.13). A low 5 min Apgar score remained a significant risk factor for neurological hospitalizations after adjusting for preterm delivery, maternal age, hypertension during pregnancy, gestational diabetes mellitus, chorioamnionitis, and delivery mode (adjusted hazard ratio = 1.61; 95%CI 1.39-1.87). However, after modeling term and preterm offspring separately, a low 5 min Apgar score was independently associated with neurological hospitalizations only among offspring born at term (adjusted hazard ratio = 1.16; 95%CI 0.87-1.55 and 1.70; 95%CI 1.42-2.02 for preterm and term offspring, respectively). (4) Conclusions: A low 5 min Apgar score is independently associated with childhood neurological morbidity, specifically among term-born offspring. Although not designed to identify risk for long-term health complications, Apgar scores may be a marker of risk for short- and long-term neurological morbidities among term newborns.

Project description:ObjectivesThe aim of this study was to evaluate the association between vasoactive-inotropic score (VIS), calculated in the 24 h after heart transplantation, and post-transplant mortality and morbidity.MethodsThis was an observational single-centre retrospective study. Patients admitted to surgical intensive care unit after transplantation, between January 2015 and December 2018, were reviewed consecutively. VISmax was calculated as dopamine+ dobutamine+ 100 × epinephrine + 100 × norepinephrine + 50 × levosimendan + 10 × milrinone (all in µg/kg/min) + 10 000 × vasopressin (units/kg/min), using the maximum dosing rates of vasoactive and inotropic medications in the 24 h after intensive care unit admission. The primary outcome was mortality at 1 year post-transplant. The secondary outcomes included length of stay, duration of mechanical ventilation and inotropic support and the occurrence of septic shock, ventilator-associated pneumonia, bloodstream infection or renal replacement therapy.ResultsA total of 151 patients underwent heart transplantation and admitted to intensive care unit. The median VISmax was 39.2 (interquartile range = 19.4-83.0). VISmax was independently associated with 1-year post-transplant mortality, as well as recipient age [hazard ratio (HR) = 1.004, P-value = 0.013], recipient gender (female to male: hazard ratio = 2.23, P-value = 0.047) and combined transplantation (hazard ratio = 2.85, P-value = 0.048). There was a significant association between VISmax and duration of mechanical ventilation (P-value < 0.001), length of stay (P-value = 0.002), duration of infused inotropes (P-value < 0.001), occurrence of bloodstream infections, septic shocks, ventilation-acquired pneumonia and renal replacement therapy.ConclusionsVISmax calculated during the first 24 h after postoperative intensive care unit admission in transplanted patients is independently associated with 1-year mortality. In addition, length of stay, duration of mechanical ventilation and infused inotropes increased with increasing VISmax.

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The association between 5-min Apgar score and mortality disappears after 24 h at the borderline of viability.

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The association between 5-min Apgar score and mortality disappears after 24 h at the borderline of viability.

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