Newborn assessment and long-term adverse outcome: a systematic review

The medical literature was searched for publications between 1966 and September 1997 for data on the association of Apgar score, umbilical blood pH, or Sarnat grading of encephalopathy with long-term adverse outcome. Odds ratios for these associations were combined to calculate common odds ratios with 95% confidence intervals. Our search identified abstracts of 1312 studies and 81 articles with sufficient numeric data to formulate contingency tables. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by comparing umbilical artery pH <7 with pH >/=7 (common odds ratio 43; 95% confidence interval 15-124) and by comparing Sarnat grade III with grade II (common odds ratio 24; 95% confidence interval 13-45). In the prediction of cerebral palsy, the strongest associations were found for Sarnat grade III versus grade II (common odds ratio 20; 95% confidence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (common odds ratio 15; 95% confidence interval 5-50).