The continuing value of the apgar score for the assessment of newborn infants.
The continuing value of the apgar score for the assessment of newborn infants.
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DOI：
10.1056/nejm200102153440701
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发表时间：
2001-02-15
影响因子：
158.5
通讯作者：
Leveno, KJ
中科院分区：
文献类型：
--
作者：
Casey, BM;McIntire, DD;Leveno, KJ
背景：近 50 年来，世界各地一直使用 10 分 Apgar 评分来评估新生儿的状况和预后。一些研究者提出，测量脐动脉血的pH值是评估新生儿的更客观的方法。方法：我们对1988年1月至1998年12月期间在市中心公立医院分娩的151,891名妊娠26周或以后的无畸形活产单胎婴儿进行了回顾性队列分析。确定了配对阿普加评分和脐动脉血pH值对 145,627 名婴儿进行评估，评估哪种测试最能预测出生后 28 天内的新生儿死亡。结果：对于 13,399 名足月前出生的婴儿（妊娠 26 至 36 周），五分钟阿普加评分为 0 至 3 的婴儿的新生儿死亡率为每 1000 人 315 人，而五分钟阿普加评分为 1 的婴儿的新生儿死亡率为每 1000 人 5 人。 7至10。在132,228名足月（妊娠37周或以后）出生的婴儿中，五分钟Apgar评分为0至3的婴儿的死亡率为每1000人244人，而五分钟Apgar评分为7至10的婴儿的死亡率为每1000人0.2人。五分钟Apgar评分为0至3的足月儿的新生儿死亡风险（相对风险，1460；95% 置信区间，835 至 2555）是脐动脉血 pH 值为 7.0 或更低的足月婴儿风险的八倍（相对风险，180；95% 置信区间，97 至 334）。结论：阿普加评分系统今天与近 50 年前一样，对于新生儿存活率的预测仍然具有相关性。 （N Engl J Med 2001；344：467-71。）版权所有 (C) 2001 马萨诸塞州医学会。
Background: The 10-point Apgar score has been used to assess the condition and prognosis of newborn infants throughout the world for almost 50 years. Some investigators have proposed that measurement of pH in umbilical-artery blood is a more objective method of assessing newborn infants.Methods: We carried out a retrospective cohort analysis of 151,891 live-born singleton infants without malformations who were delivered at 26 weeks of gestation or later at an inner-city public hospital between January 1988 and December 1998. Paired Apgar scores and umbilical-artery blood pH values were determined for 145,627 infants to assess which test best predicted neonatal death during the first 28 days after birth.Results: For 13,399 infants born before term (at 26 to 36 weeks of gestation), the neonatal mortality rate was 315 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 5 per 1000 for infants with five-minute Apgar scores of 7 to 10. For 132,228 infants born at term (37 weeks of gestation or later), the mortality rate was 244 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 0.2 per 1000 for infants with five-minute Apgar scores of 7 to 10. The risk of neonatal death in term infants with five-minute Apgar scores of 0 to 3 (relative risk, 1460; 95 percent confidence interval, 835 to 2555) was eight times the risk in term infants with umbilical-artery blood pH values of 7.0 or less (relative risk, 180; 95 percent confidence interval, 97 to 334).Conclusions: The Apgar scoring system remains as relevant for the prediction of neonatal survival today as it was almost 50 years ago. (N Engl J Med 2001;344:467-71.) Copyright (C) 2001 Massachusetts Medical Society.