Advertisement

Depressed Apgar scores, acid-base status, and neurologic outcome

      Abstract

      OBJECTIVE: Our purpose was to determine the acid-base status of neonates with an Apgar score ≤3 at 5 minutes and to ascertain whether accompanying acidemia is an important predictor of immediate newborn morbidity and long-term neurologic development. STUDY DESIGN: From January 1984 through December 1991 there were 28 newborns with gestational age ≥34 weeks or birth weight≥2000 gm in whom the Apgar score at 5 minutes was ≤3 and for whom umbilical cord arterial blood gas measurements were retrievable from the perinatal database. The neonates were grouped according to whether the immediate newborn course was complicated (n = 16) or uncomplicated (n = 12). Analysis of variables between these two groups and between those neonates in the complicated group who were later assessed to be developmentally normal (n = 6) or to have cerebral palsy (n = 6) was performed by Fisher's exact test, unpaired Student t test, Mann-Whitney U test, analysis of variance, or multiple logistic regression. RESULTS: Seventeen of 28 (60.7%) neonates with an Apgar score of ≤3 at 5 mintues had an umbilical cord arterial pH > 7.00, and in 15 (53.6%) cases the pH was >7.10. Neonates with a complicated newborn course had a significantly lower mean pH (6.94 ± 0.19 vs 7.14 ± 0.11, p < 0.01) and a significantly greater mean base deficit (14.8 ± 6.3 mmol/L vs 6.4 ± 4.0 mmol/L, p < 0.001). However, within this group there were no differences in umbilical cord arterial blood gas measurements between those children who were subsequently normal versus those with cerebral palsy. Multiple logistic regression analysis could not identify any newborn morbidity predictive of long-term neurologic development in those neonates with a complicated newborn course. CONCLUSIONS: Neonates with an Apgar score ≤3 at 5 minutes and a complicated newborn course were more likely to be delivered by cesarean section for fetal heart rate abnormalities and to have lower umbilical cord arterial pH measurements and higher base deficit values than did their counterparts with an uncomplicated newborn course. No neonatal variable, however, was predictive of chronic neurologic disability within the group of neonates with a complicated newborn course. (AM J OBSTET GYNECOL 1994;170:991-9.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nelson KB
        • Ellenberg JH.
        Apgar scores as predictors of chronic neurologic disability.
        Pediatrics. 1981; 68: 36-44
        • Scott H.
        Outcome of very severe birth asphyxia.
        Arch Dis Child. 1976; 51: 712-716
        • Thomson AJ
        • Searle M
        • Russell G.
        Quality of survival after severe birth asphyxia.
        Arch Dis Child. 1977; 52: 620-626
        • Ellenberg JH
        • Nelson KB.
        Cluster of perinatal events identifying infants at high risk for death or disability.
        J Pediatr. 1988; 113: 546-552
        • Freeman JM
        • Nelson KB.
        Intrapartum asphyxia and cerebral palsy.
        Pediatrics. 1988; 82: 240-249
        • Gilstrap LC
        • Leveno KJ
        • Burris J
        • Williams ML
        • Little BB.
        Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction.
        AM J OBSTET GYNECOL. 1989; 161: 825-830
        • Fee SC
        • Malee K
        • Deddish R
        • Minogue JP
        • Socol ML.
        Severe acidosis and subsequent neurologic status.
        AM J OBSTET GYNECOL. 1990; 162: 802-806
        • Winkler CL
        • Hauth JC
        • Tucker JM
        • Owen J
        • Brumfield CG.
        Neonatal complications at term as related to the degree of umblical artery acidemia.
        AM J OBSTET GYNECOL. 1991; 164: 637-641
        • Goldaber KG
        • Gilstrap LC
        • Leveno KJ
        • Dax JS
        • McIntire DD.
        Pathologic fetal acidemia.
        Obstet Gynecol. 1991; 78: 1103-1107
        • Goodwin TM
        • Belai I
        • Hernandez P
        • Durand M
        • Paul RH.
        Asphyxial complications in the term newborn with severe umbilical acidemia.
        AM J OBSTET GYNECOL. 1992; 167: 1506-1512
        • Low JA
        • Muir DW
        • Pater EA
        • Karchmar EJ.
        The association of intrapartum asphyxia in the mature fetus with newborn behavior.
        AM J OBSTET GYNECOL. 1990; 163: 1131-1135
        • Low JA
        • Galbraith RS
        • Muir DW
        • Killen HL
        • Pater EA
        • Karchmar EJ.
        Motor and cognitive deficits after intrapartum asphyxia in the mature fetus.
        AM J OBSTET GYNECOL. 1988; 158: 356-361
        • Dennis J
        • Johnson A
        • Mutch L
        • Yudkin P
        • Johnson P.
        Acid-base status at birth and neurodevelopmental outcome at four and one-half years.
        AM J OBSTET GYNECOL. 1989; 161: 213-220
        • Brazelton TB.
        Behavioral assessment scale.
        2nd ed. Spastics International, London1984
        • Bayley N.
        Bayley scales of infant development.
        Psychological Corp, New York1969
        • Thorndike RL
        • Hagen EP
        • Satter JM.
        The Stanford-Binet intelligence scale.
        4th ed. Riverside, Chicago1986
        • Wechsler D.
        Wechsler preschool and primary scale of intelligence —revised.
        Harcourt Brace Jovanovich, San Antonio, Texas1989
        • Wechsler D.
        Wechsler intelligence scale for children — revised.
        Psychological Corp, New York1974
        • Haenzel W
        • Loveland D
        • Sirken MG.
        Lung-cancer mortality as related to residence and smoking histories.
        J Natl Cancer Inst. 1962; 28: 947-1001
        • Brenner WE
        • Edelman DA
        • Hendricks CH.
        A standard of fetal growth for the United States of America.
        AM J OBSTET GYNECOL. 1976; 126: 555-564
        • American College of Obstetricians
        • Gynecologists
        Fetal and neonatal neurologic injury.
        American College of Obstetricians and Gynecologists, Washington, DC1992 (ACOG Technical Bulletin no 163)
        • Peeters LH
        • Sheldon RE
        • Jones MD
        • Makowski EL
        • Meschia G.
        Blood flow to fetal organs as a function of arterial oxygen content.
        AM J OBSTET GYNECOL. 1979; 135: 637-646
        • Bocking AD
        • Gagnon R
        • White SE
        • Homan J
        • Milne KM
        • Richardson BS.
        Circulatory responses to prolonged hypoxemia in fetal sheep.
        AM J OBSTET GYNECOL. 1988; 159: 1418-1424
        • Sexon WR
        • Sexon SB
        • Rawson JE
        • Brann AW.
        The multisystem involvement of the asphyxiated newborn.
        Pediatr Res. 1976; 10: 432
        • Tack E
        • Perlman JM
        • Hausel C
        • Griften M
        • Martin T.
        Systemic manifestations of perinatal asphyxia in the newborn.
        Pediatr Res. 1986; 20: 362A
        • Low JA
        • Galbraith RS
        • Muir DW
        • Killen HL
        • Pater EA
        • Karchmar EJ.
        Intrapartum fetal hypoxia: a study of long-term morbidity.
        AM J OBSTET GYNECOL. 1983; 145: 129-134
        • Nelson KB
        • Ellenberg JH.
        The asymptomatic newborn and risk of cerebral palsy.
        Am J Dis Child. 1987; 141: 1333-1335
        • Ruth VJ
        • Raivio KO.
        Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score.
        BMJ. 1988; 297: 24-27
        • Robertson C
        • Finer N.
        Term infants with hypoxic-ischemic encephalopathy: outcome at 3-5 years.
        Dev Med Child Neurol. 1985; 27: 473-484
        • Ruth VJ
        • Raivio KO.
        Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score.
        BMJ. 1988; 297: 24-27
        • American College of Obstetricians
        • Gynecologists
        Fetal and neonatal neurologic injury.
        American College of Obstetricians and Gynecologists, Washington1992 (American College of Obstetricians and Gynecologists Technical Bulletin no 163)
        • Nelson KB.
        Perspective on the role of perinatal asphyxia in neurologic outcome: Its role in developmental deficits in children.
        Can Med Assoc J. 1989; 141: 3-10