A study to determine the association between 5 minute APGAR Scores in term newborns and mortality neonatal encephalopathy and neurodevelopment at eight weeks postnatal age, at the University Teaching Hospital
Date
2016
Authors
Chola, Ronald
Journal Title
Journal ISSN
Volume Title
Publisher
University of Zambia
Abstract
In 1952, Virginia Apgar devised a system of scores as a means of evaluating the physical
condition of the newborn immediately after birth. The Apgar score has since been accepted
for use to assess newborns in almost all labour wards worldwide.
While infant mortality is reducing worldwide, neonatal morbidity is increasing. Improved
resuscitation techniques have improved neonatal survival, what is not yet known is how many
of these babies survive without sequelae.
This study sought to validate the association between 5 minute Apgar scores and mortality,
neonatal encephalopathy and adverse neurodevelopment at 8 weeks postnatal age at the
University Teaching Hospital, Zambia.
Methods
A total of 140 study subjects, meeting the inclusion criteria and consenting parents took part
in the study to determine the association between 5 minute Apgar scores in term newborns
and neonatal mortality, neonatal encephalopathy and neurodevelopment at 8 weeks postnatal
age. The study subjects had their 5 minute Apgar scores taken by specially retrained
midwives equipped with stop watches. Neonatal encephalopathy at 6-12 hours was assessed
with a clinical neurological examination by the PI. At eight weeks postnatal age, their mental
and motor development was assessed by the PI with the Bayley Scale of Infant Development
II. Cross-tabulations and chi-square calculations in SPSS 20.0 windows version were used to
assess the relationships between the Apgar scores and mortality, encephalopathy at age 6-12
hours, mental and motor development at eight weeks.
Results
Very low 5 minute Apgar scores (0-3) were associated with 73.3 % (22/30, OR 30.9)
neonatal mortality. Very low Apgar scores (0-3) were associated with significant (moderate
to severe) encephalopathy at 6 to 12 hours of age (83.3%, OR 25.6).
Infants with very low 5 minute scores were 9.2 and 8 times more likely have delayed mental
(OR 9.2) and motor (OR 7.7) development respectively, at eight weeks postnatal age.
v
High mortality (22.1%) and high follow up loss (38.6%) in the very low Apgar group made
the later part of the study not statistically significant, thus needing further larger long term
research.
Conclusion
The results of this study underscores the evidence, as reported from other studies, that Apgar
scores can be used to identify infants at increased risk of neonatal encephalopathy and death,
needing greater and immediate attention. Furthermore, the study has demonstrated the ability
of Apgar scores to identify children who need further neurodevelopmental follow-up.
Description
M.MEDICINE
Keywords
Infant,Newborn , Infant,Newborn,Diseases , Pediatric Neurology