Apgar score effective in assessing health of preterm infants

Date:
July 2, 2020
Source:
Karolinska Institutet
Summary:
The vitality of preterm infants should be assessed with an Apgar
score, a tool used to measure the health of newborns immediately
after birth. That is the conclusion by researchers who in a large
observational study examined the value of Apgar scores for preterm
infants.



FULL STORY ==========================================================================
The vitality of preterm infants should be assessed with an Apgar score, a
tool used to measure the health of newborns immediately after birth. That
is the conclusion by researchers at Karolinska Institutet in Sweden who
in a large observational study examined the value of Apgar scores for
preterm infants. The findings are published in the New England Journal
of Medicine.


==========================================================================
The so-called Apgar score has been used since the 1950s to quickly assess
the vitality of the infant soon after birth. Doctors and midwifes measure
five parameters in the infant -- heart activity, respiration, muscle tone, irritability and color -- and give each parameter a score from 0-2. The
total score can thus range from 0 to 10, where a higher number indicates
better health and a greater chance of survival.

However, some have questioned the value of the Apgar score in preterm
infants, since the immaturity of these infants may lead to lower scores compared with infants born at term. Therefore, the researchers in this
study wanted to find out if the Apgar score could be used to predict the mortality risk of preterm infants during the first four weeks of life
(the neonatal period).

Using Swedish nationwide register data, the researchers studied 113,000
non- malformed infants born after 22 to 36 weeks of pregnancy in the
years 1992- 2016. The risk of neonatal mortality was calculated for
Apgar scores at five and ten minutes after birth, and separate analyses
were performed for infants born at 22-24, 25-27, 28-31, 32-34 and 35-36 gestational weeks.

A total of 1,986 (1.8 percent) preterm infants died in the neonatal
period. As expected, the neonatal death rate sharply increased with
shorter pregnancy length, from 0.2 percent for infants born at 36 weeks to
76.5 percent for those born at 22 weeks. Regardless of pregnancy length,
the risk of neonatal death increased with a lower Apgar score. For
children born very prematurely, a lower Apgar score significantly
increased the absolute risk of neonatal mortality.

Even a slight increase in Apgar score from five to ten minutes after
birth was associated with a lower risk of neonatal death.

"Our results show the importance of registering Apgar score also
in preterm infants," says Sven Cnattingius, senior professor at the
Department of Medicine, Solna, Karolinska Institutet, and the study's corresponding author.

"It is important that infants with reduced scores receive full clinical attention regardless of gestational age." "Heart activity and breathing
are the cornerstones of the Apgar assessment," says co-author Stefan
Johansson, associate professor at the Department of Medicine, Solna,
Karolinska Institutet and neonatologist at the Sachsska children and
youth hospital in Stockholm. "Our research indicates that the chance of survival increases the better you are at stabilizing the premature baby's circulation and breathing immediately after birth." The researchers
considered several confounding factors that could impact the outcome,
including the mother's age, smoking, weight, blood-pressure, infant's
mode of delivery and year of birth. The researchers note that the study
is based on Swedish conditions and that the results may be different in
other countries.

"Although it is frustrating that we usually cannot pinpoint the causes of
a reduced Apgar score, we need to embrace that the score is, independent
of gestational age, the best available tool we have to evaluate the
newborn's health in the delivery room," says Neda Razaz, assistant
professor in the same department.

Around 115,000 non-malformed children are born in Sweden annually,
and slightly more than 5 percent are born preterm. Of these, around
150 children die during the neonatal period, of which around 100 are
born preterm.

The study was funded by grants from the Swedish Research Council
for Health, Working Life and Welfare and by Karolinska Institutet's Distinguished Professor Award to Sven Cnattingius.


========================================================================== Story Source: Materials provided by Karolinska_Institutet. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Sven Cnattingius, Stefan Johansson, Neda Razaz. Apgar Score and
Risk of
Neonatal Death among Preterm Infants. New England Journal of
Medicine, 2020; 383 (1): 49 DOI: 10.1056/NEJMoa1915075 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200702115030.htm

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