10/17/2023 0 Comments Apgar score![]() The study draws on data from the Malaysian, National Obstetrics Registry (NOR). The factors associated with recovery from a 1 min Apgar score <4 The patterns of Apgar score change in newborns from 1 to 5 min and With a focus on term, newborns with low one minute Apgar scores, we examine: Understanding the factors associated with the transition between the scores, particularly for neonates with 1 min Apgar scores <4 has the potential to bring into relief points for intervention or further investigation. Variation in recovery rates between the first and fifth minute provides significant clinical information and may, furthermore, provide insight into health systems issues in the intrapartum window. It is for this reason that the second Apgar assessment, made at 5 min, is a better predictor of later outcomes than the Apgar score at 1 min (7).įor a neonate with an initially poor Apgar score, the difference between the 1st and 5th minute Apgar scores indicates the capacity to recover and the potential need for ongoing management. The Apgar assessment at 5 min provides an indication of a neonate’s sustained capacity to survive and thrive. ![]() A 1 min Apgar score <4 is likely to trigger a range of protocols which may (or may not) lead to resuscitative intervention. The major difference between the Apgar assessment at 1 and 5 min is that the Apgar assessment within the first minute of birth provides an indication of intrapartum health and the neonatal response to the “trauma” of birth. Understanding the factors associated with the transition from intrauterine to extrauterine life, particularly for neonates with 1 min Apgar scores <4, has the potential to improve care. While the Apgar score at 5 min is a better predictor of later outcomes than the Apgar score at 1 min, there is a necessary temporal process involved, and a neonate must pass through the first minute of life to reach the fifth. There appears to have been little or no research examining the relationship between the Apgar score at 1 min and the Apgar score at 5 min. Research has generally focused on the Apgar score at 5 min, and more specifically the relationship between the Apgar score at 5 min and future neonatal and infant outcomes. The assessment is usually made a number of times within the first ten minutes of birth, usually at 1, 5, and 10 min. The most consistently used measure of neonatal health in the few minutes after delivery is the Apgar score, providing labor ward staff with a shared understanding of a newborn’s status, and the possible need for and response to resuscitation. These are associations only, not necessarily causes, and they point to potential areas of research into health systems factors in the labour room, as well as possible biological and cultural factors. In those newborns the qualification of the person performing the delivery and the type of delivery are independent predictors of recovery as is maternal BMI and ethnicity. ConclusionsĪ 1 min Apgar score <4 is relatively rare, and less than a third recover by five minutes. Recovery was also associated with maternal obesity, and there was some ethnic variation – in the adjusted analysis indigenous (Orang Asal) Malaysians had lower odds of recovery. Among deliveries of neonates with a 1 min Apgar score <4 by doctors, after controlling for other factors, planned and unplanned CS was associated with better odds of recovery than uncomplicated vaginal deliveries. Among uncomplicated vaginal deliveries, after controlling for other factors, deliveries by a doctor of neonates with a 1 min Apgar score <4 had odds of recovery 2.4 times greater than deliveries of neonates with a 1 min Apgar score <4 by a nurse-midwife. Only 29.4% of neonates with 1 min Apgar scores <4 recover to a 5 min Apgar score ≥7. Less than 1% of births have a 1 min Apgar scores <4. Descriptive methods and bi- and multi-variable logistic regression were used to identify risk factors associated with recovery (5 min Apgar score ≥7) from 1 min Apgar scores <4. A total of 272,472 live, singleton, term births without congential anomalies were recorded, of which 1,580 (0.59%) had 1 min Apgar scores <4. MethodsĪn analysis of observational data was conducted using live, singleton, term births recorded in the Malaysian National Obstetrics Registry between 20. There has been no research looking at predictors of recovery (Apgar scores ≥7) by 5 min in neonates with 1 min Apgar scores <4. A baby, however, must pass through the first minute of life to reach the fifth. ![]() The neonatal Apgar score at 5 min has been found to be a better predictor of outcomes than the Apgar score at 1 min. ![]()
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