Trends in neonatal outcome with low Apgar scores

Abstract

Trends in incidence and neonatal outcome following low Apgar scores (1 min Apgar score < 6) were prospectively studied during the years (1981, 1983, 1986 and 1988. The incidence of birth asphyxia was 7.6% of live births during the study period; it was 5.8% in 1981, increased to highest of 8.9% in 1986 with slight reduction to 7.2% in 1988. Birth weight distribution of asphyxiated babies and 1 min Apgar score < 3 (severe asphyxia) remained unchanged. A significant decline in neonatal mortality with asphyxia was noted from 46.0% to 28.4% during 1981 and 1988 respectively. Aetiological factors for asphyxia could be identified in nearly 90% of infants during 1988, and all but 2 of 12 factors studied registered significant differences from control non-asphyxiated group.

PIP: Pediatricians conducted a prospective study of 35,959 live births at Smt. Sucheta Kripalani Hospital in New Delhi in 1981, 1983, 1986, and 1988 to determine whether or not new technology and equipment, resulting in improved obstetric and neonatal services, have affected the trends in neonatal outcome with low Apgar scores (=or 3) (indicating severe birth asphyxia). The overall incidence of low Apgar score was 7.6%. It increased significantly from 1981 to 1986 (5.8-8.9%; p 0.001). It fell somewhat in 1988 to 7.2%. There was a significant decrease in the proportion of neonates with a very low 1-minute Apgar score (52.8-36.5%; p 0.001), however, suggesting that the severity of intrapartum asphyxia fell due to more early intervention (e.g., fetal monitoring and cesarean section). The birth weight distribution of newborns with birth asphyxia did not change greatly between 1981 and 1988. Neonatal mortality of infants with birth asphyxia declined between 1981 and 1988 (p 0.001) (46-23.5%, 1981-1986, slight rise in 1988 to 28.4%). Even though neonatal mortality fell significantly for both infants weighing at least 2001 g and those weighing 2000 g or less (p 0.001), the heavier infants experienced the greatest reduction in mortality (54.8% vs. 34.4%). Newborns with low Apgar scores or their mothers were significantly (p 0.01) more likely to have a cesarean section (36.4% vs. 10.3%; odds ratio [OR] = 4.9), fetal distress (29.1% vs. 7.8%; OR = 4.9), abnormal presentation (18.1% vs. 4.8%; OR = 4.4), preeclampsia/eclampsia (17.1% vs. 10.2%; OR = 1.8), abnormal labor (13.5% vs. 2.3%; OR = 6.6), PROM (11% vs. 4.6%; OR = 2.6), twins (5.6% vs. 1.7%; OR = 3.4), and other risk factors (8.3% vs. 3.1%; OR = 2.8). Most newborns with low Apgar scores (85%) had identifiable risk factors compared to only 34% of controls. These findings show that improved obstetric and neonatal services increased neonatal survival and that prolonged hypoxia remains a challenge. Early referral and regionalization of perinatal services would further reduce asphyxia-related neonatal mortality.