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Published on: June 5, 2014
Association between low Apgar score and neonatal cholestasis
B Fischler1, M Pettersson, A Hjern
1Department of Paediatrics, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden. bjorn.fischler@hs.se
Insights
Low Apgar scores are not more common in infants with cholestasis than in the general newborn population. Further investigation into other causes is needed for cholestasis of unknown origin.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Perinatal Health
Background:
- Cholestasis in infants is a serious condition requiring prompt diagnosis.
- The Apgar score is a key indicator of newborn health at birth.
Purpose of the Study:
- To determine if a low Apgar score is associated with the development of infant cholestasis.
- To explore potential links between Apgar scores and specific causes of cholestasis.
Main Methods:
- Retrospective study of 77 cholestatic infants and over 1 million controls.
- Data sourced from the Swedish Medical Birth Registry, including Apgar scores, gestational age, and birthweight.
- Medical records reviewed for neonatal distress in infants with low Apgar scores.
Main Results:
- Only five cholestatic infants met the criteria for a low Apgar score, primarily premature infants.
- Two cases were explained by major surgical issues; three had signs of neonatal distress (two with biliary atresia, one with Alagille syndrome).
- Incidence of low Apgar scores in biliary atresia (7%) and unknown cholestasis (0%) did not significantly differ from controls (2.6%).
Conclusions:
- A low Apgar score is not a more frequent finding in cholestatic infants compared to the general newborn population.
- Etiological factors beyond a low Apgar score should be investigated for infants presenting with unexplained cholestasis.
Aim:
To investigate the association between low Apgar score and the development of cholestasis.
Methods:
Seventy-seven cholestatic infants, all referred to our tertiary centre and born between 1987 and 1996 were studied. Twenty-eight patients had biliary atresia (BA), 36 had various intrahepatic disorders and for 13 patients the aetiology of the cholestasis was unknown. Data on gestational age, mode of delivery, Apgar score and birthweight for the cholestatic infants and 1,118,270 control subjects born during the same time period were obtained from the Swedish Medical Birth Registry. If the Apgar score of the cholestatic patient was <7 at 1 min and/or <9 at 5 min and/or <9 at 10 min of age the available medical records were reviewed for signs of neonatal distress.
Results:
Five cholestatic patients, all of them premature, fulfilled the Apgar criteria. For two of them the low Apgar score and need for immediate resuscitation were explained by major surgical problems. The other three patients, two with biliary atresia (BA) and one with Alagille syndrome, had clinical signs of neonatal distress. The incidence of low Apgar score in BA patients was 7% and in cholestatic patients without known aetiology 0%, neither figure differing significantly from that of the of the control group (2.6%).
Conclusion:
Low Apgar score is not more common in any of the cholestatic groups than in the general Swedish population of newborns. We suggest that aetiological associations other than low Apgar score need to be considered in infants with cholestasis of unknown cause.
