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Outcome of term infants using apgar scores at 10 minutes following hypoxic-ischemic encephalopathy
Abbot R Laptook1, Seetha Shankaran, Namasivayam Ambalavanan
1Department of Pediatrics, Women & Infants' Hospital of Rhode Island, Providence, Rhode Island 02906, USA. alaptook@wihri.org
Insights
Apgar scores at 10 minutes can predict early childhood death or disability in infants with hypoxic-ischemic encephalopathy. Lower scores indicate a higher risk, offering early prognostic insight.
Area of Science:
- Neonatal research
- Pediatric neurology
- Clinical outcomes
Background:
- Perinatal hypoxic-ischemic encephalopathy (HIE) poses significant risks for newborns.
- Early prediction of neurodevelopmental outcomes in HIE is crucial for timely intervention.
- Apgar scores are routinely assessed at birth, but their prognostic value at later time points requires further investigation.
Purpose of the Study:
- To investigate the association between 10-minute Apgar scores and subsequent death or disability in infants with HIE.
- To evaluate the prognostic utility of 10-minute Apgar scores in predicting long-term neurodevelopmental outcomes.
Main Methods:
- Secondary analysis of infants from the NICHD Neonatal Research Network hypothermia trial.
- Inclusion criteria: gestational age >=36 weeks, clinical/biochemical abnormalities, encephalopathy within 6 hours of birth.
- Statistical analyses included logistic regression and classification and regression-tree analysis to assess the association between 10-minute Apgar scores and death/disability at 18-22 months.
Main Results:
- Apgar scores at 10 minutes showed a shift towards higher values compared to earlier scores.
- Each one-point decrease in the 10-minute Apgar score was linked to a 45% increased odds of death or moderate/severe disability.
- High rates of death or disability were observed in infants with 10-minute Apgar scores of 0-2 (76-82%).
Conclusions:
- 10-minute Apgar scores offer valuable prognostic information for infants with HIE before other assessments are available.
- While death or disability is common with scores below 3, outcomes are not uniform, necessitating caution in guiding resuscitation duration based solely on this metric.
Objective:
The objective of this study was to determine whether Apgar scores at 10 minutes are associated with death or disability in early childhood after perinatal hypoxic-ischemic encephalopathy.
Methods:
This was a secondary analysis of infants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial. Infants who were born at >or=36 weeks' gestation and had clinical and/or biochemical abnormalities at birth and encephalopathy at <6 hours were studied. Logistic regression and classification and regression-tree analysis were used to determine associations between Apgar scores at 10 minutes and neurodevelopmental outcome, adjusting for covariates. Death or disability (moderate or severe) at 18 to 22 months of age was the measured outcome.
Results:
Twenty of 208 infants were excluded (missing data). More than 90% of the infants had Apgar scores of 0 to 2 at 1 minute, and Apgar scores at 5 and 10 minutes shifted to progressively higher values; at 10 minutes, 27% of infants had Apgar scores of 0 to 2. After adjustment, each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the odds of death or disability. Death or disability occurred in 76%, 82%, and 80% of infants with 10-minute Apgar scores of 0, 1, and 2, respectively. Classification and regression-tree analysis indicated that Apgar scores at 10 minutes were discriminators of outcome.
Conclusions:
Apgar scores at 10 minutes provide useful prognostic data before other evaluations are available for infants with hypoxic-ischemic encephalopathy. Death or moderate/severe disability is common but not uniform with Apgar scores of <3; caution is needed before adopting a specific time interval to guide duration of resuscitation.
