提示: 手机请竖屏浏览!

早产儿阿普加评分与新生儿死亡风险的关系
Apgar Score and Risk of Neonatal Death among Preterm Infants


Sven Cnattingius ... 妇产科和儿科 • 2020.07.02
相关阅读
• 早产儿的氧饱和度限制:当下定论 • 补充二十二碳六烯酸对早产儿是否有帮助

摘要


背景

胎龄是早产儿在新生儿期死亡(在出生后28天内死亡)的主要决定因素。胎龄和阿普加评分对新生儿死亡风险的联合影响尚不明确。

 

方法

我们利用瑞典医学出生登记系统(Swedish Medical Birth Register)的数据确定了1992—2016年出生的113,300名早产儿(妊娠22周0天至36周6天)。在根据胎龄(22~24周、25~27周、28~31周、32~34周以及35周或36周)分层的分析中,我们根据5分钟和10分钟阿普加评分,以及根据5分钟和10分钟之间的阿普加评分变化估计了新生儿死亡的校正相对危险度和新生儿死亡率的绝对率差(即每100例出生中的新生儿超额死亡数量)。评分范围为0~10分,评分较高表示新生儿的身体状况较好。

 

结果

共有1,986名新生儿死亡(1.8%)。新生儿死亡率范围为0.2%(妊娠36周)~76.5%(妊娠22周)。在所有胎龄层中,较低的阿普加评分均与较高的新生儿死亡相对危险度以及较大的新生儿死亡率绝对率差相关。例如,在28~31周出生的婴儿中,根据5分钟阿普加评分,将评分为9分或10分的婴儿作为参照组,对于评分为0分或1分、2分或3分、4~6分以及7分或8分的婴儿,校正绝对率差分别为51.7(95%置信区间[CI],38.1~65.4)、25.5(95% CI,18.3~32.8)、7.1(95% CI,5.1~9.1)和1.2(95% CI,0.5~1.9)。与5分钟和10分钟之间阿普加评分保持稳定相比,阿普加评分提高与较低的新生儿死亡率相关。

 

结论

在本研究中,在各胎龄层的早产儿中,5分钟和10分钟阿普加评分提供了关于新生儿生存的预后信息(由瑞典卫生、工作、生活和福利研究委员会[Swedish Research Council for Health,Working Life,and Welfare]和卡罗林斯卡医学院[Karolinska Institutet]资助)。





作者信息

Sven Cnattingius, M.D., Ph.D., Stefan Johansson, M.D., Ph.D., and Neda Razaz, Ph.D.
From the Division of Clinical Epidemiology, Department of Medicine Solna (S.C., S.J., N.R.), and the Department of Clinical Science and Education (S.J.), Karolinska Institutet, Stockholm. Address reprint requests to Dr. Cnattingius at the Division of Clinical Epidemiology, Department of Medicine Solna, T2, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden, or at sven.cnattingius@ki.se.

 

参考文献

1. Harrison MS, Goldenberg RL. Global burden of prematurity. Semin Fetal Neonatal Med 2016;21:74-79.

2. Medlock S, Ravelli AC, Tamminga P, Mol BW, Abu-Hanna A. Prediction of mortality in very premature infants: a systematic review of prediction models. PLoS One 2011;6(9):e23441-e23441.

3. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953;32:260-267.

4. Drage JS, Kennedy C, Schwarz BK. The Apgar score as an index of neonatal mortality: a report from the Collaborative Study of Cerebral Palsy. Obstet Gynecol 1964;24:222-230.

5. Iliodromiti S, Mackay DF, Smith GCS, Pell JP, Nelson SM. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet 2014;384:1749-1755.

6. Razaz N, Cnattingius S, Joseph KS. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ 2019;365:l1656-l1656.

7. American Academy of Pediatrics Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar score. Pediatrics 2015;136:819-822.

8. Catlin EA, Carpenter MW, Brann BS IV, et al. The Apgar score revisited: influence of gestational age. J Pediatr 1986;109:865-868.

9. Hegyi T, Carbone T, Anwar M, et al. The Apgar score and its components in the preterm infant. Pediatrics 1998;101:77-81.

10. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 2001;344:467-471.

11. Tyson JE, Parikh NA, Langer J, et al. Intensive care for extreme prematurity — moving beyond gestational age. N Engl J Med 2008;358:1672-1681.

12. Lee HC, Subeh M, Gould JB. Low Apgar score and mortality in extremely preterm neonates born in the United States. Acta Paediatr 2010;99:1785-1789.

13. Weinberger B, Anwar M, Hegyi T, Hiatt M, Koons A, Paneth N. Antecedents and neonatal consequences of low Apgar scores in preterm newborns: a population study. Arch Pediatr Adolesc Med 2000;154:294-300.

14. Bartman T, Bapat R, Martin EM, Shepherd EG, Nelin LD, Reber KM. Apgar score at 5 minutes is associated with mortality in extremely preterm infants even after transfer to an all referral NICU. Am J Perinatol 2015;32:1268-1272.

15. Wyckoff MH, Salhab WA, Heyne RJ, et al. Outcome of extremely low birth weight infants who received delivery room cardiopulmonary resuscitation. J Pediatr 2012;160(2):239-244.e2.

16. Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 2009;24:659-667.

17. Källén B, Källén K. The Swedish Medical Birth Register: a summary of content and quality. Stockholm: Swedish National Board of Health and Welfare, 2003.

18. Brooke HL, Talbäck M, Hörnblad J, et al. The Swedish Cause of Death Register. Eur J Epidemiol 2017;32:765-773.

19. Quality and content in the Swedish Patient Register. Stockholm: Swedish National Board of Health and Welfare, 2014.

20. Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011;11:450-450.

21. Educational attainment of the population. Stockholm: Statistics Sweden, 2020 (https://www.scb.se/en/finding-statistics/statistics-by-subject-area/education-and-research/education-of-the-population/educational-attainment-of-the-population/. opens in new tab).

22. Ludvigsson JF, Almqvist C, Bonamy AK, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol 2016;31:125-136.

23. Høgberg U, Larsson N. Early dating by ultrasound and perinatal outcome: a cohort study. Acta Obstet Gynecol Scand 1997;76:907-912.

24. Marsál K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 1996;85:843-848.

25. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702-706.

26. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med 2011;30:377-399.

27. Papile LA. The Apgar score in the 21st century. N Engl J Med 2001;344:519-520.

28. O’Donnell CPF, Kamlin COF, Davis PG, Carlin JB, Morley CJ. Interobserver variability of the 5-minute Apgar score. J Pediatr 2006;149:486-489.

29. Siddiqui A, Cuttini M, Wood R, et al. Can the Apgar score be used for international comparisons of newborn health? Paediatr Perinat Epidemiol 2017;31:338-345.

30. Haumont D, Modi N, Saugstad OD, et al. Evaluating preterm care across Europe using the eNewborn European Network database. Pediatr Res 2020 January 23 (Epub ahead of print).

31. Cnattingius S, Norman M, Granath F, Petersson G, Stephansson O, Frisell T. Apgar score components at 5 minutes: risks and prediction of neonatal mortality. Paediatr Perinat Epidemiol 2017;31:328-337.

服务条款 | 隐私政策 | 联系我们