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Apgar scores at 10 min and outcomes at 6-7 years following hypoxic-ischaemic encephalopathy.

CPQCC Publication
TitleApgar scores at 10 min and outcomes at 6-7 years following hypoxic-ischaemic encephalopathy.
Publication TypeJournal Article
Year of Publication2013
AuthorsNatarajan G, Shankaran S, Laptook AR, Pappas A, Bann CM, McDonald SA, Das A, Higgins RD, Hintz SR, Vohr BR
Corporate AuthorsExtended Hypothermia Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
JournalArch Dis Child Fetal Neonatal Ed
Volume98
Issue6
PaginationF473-9
Date Published2013 Nov
ISSN1468-2052
KeywordsApgar Score, Asphyxia Neonatorum, Birth Weight, Child, Child Development, Cohort Studies, Developmental Disabilities, Female, Gestational Age, Humans, Hypothermia, Induced, Hypoxia-Ischemia, Brain, Infant, Newborn, Intelligence Tests, Logistic Models, Male, Resuscitation, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome
Abstract

AIM: To determine the association between 10 min Apgar scores and 6-7-year outcomes in children with perinatal hypoxic-ischaemic encephalopathy (HIE) enrolled in the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) whole body cooling randomised controlled trial (RCT).

METHODS: Evaluations at 6-7 years included the Wechsler Preschool and Primary Scale of Intelligence III or Wechsler Intelligence Scale for Children IV and Gross Motor Functional Classification Scale. Primary outcome was death/moderate or severe disability. Logistic regression was used to examine the association between 10 min Apgar scores and outcomes after adjusting for birth weight, gestational age, gender, outborn status, hypothermia treatment and centre.

RESULTS: In the study cohort (n=174), 64/85 (75%) of those with 10 min Apgar score of 0-3 had death/disability compared with 40/89 (45%) of those with scores >3. Each point increase in 10 min Apgar scores was associated with a significantly lower adjusted risk of death/disability, death, death/IQ <70, death/cerebral palsy (CP) and disability, IQ<70 and CP among survivors (all p<0.05). Among the 24 children with a 10 min Apgar score of 0, five (20.8%) survived without disability. The risk-adjusted probabilities of death/disability were significantly lower in cooled infants with Apgar scores of 0-3; there was no significant interaction between cooling and Apgar scores (p=0.26).

CONCLUSIONS: Among children with perinatal HIE enrolled in the NICHD cooling RCT, 10 min Apgar scores were significantly associated with school-age outcomes. A fifth of infants with 10 min Apgar score of 0 survived without disability to school age, suggesting the need for caution in limiting resuscitation to a specified duration.

DOI10.1136/archdischild-2013-303692
Alternate JournalArch Dis Child Fetal Neonatal Ed
PubMed ID23896791
PubMed Central IDPMC4166405
Grant ListU10 HD27851 / HD / NICHD NIH HHS / United States
U10 HD027856 / HD / NICHD NIH HHS / United States
U10 HD021373 / HD / NICHD NIH HHS / United States
UL1 RR024139 / RR / NCRR NIH HHS / United States
U10 HD021385 / HD / NICHD NIH HHS / United States
HD27853 / HD / NICHD NIH HHS / United States
U10 HD40492 / HD / NICHD NIH HHS / United States
U10 HD21364 / HD / NICHD NIH HHS / United States
U10 HD34216 / HD / NICHD NIH HHS / United States
U10 HD021364 / HD / NICHD NIH HHS / United States
U10 HD027880 / HD / NICHD NIH HHS / United States
U10 HD36790 / HD / NICHD NIH HHS / United States
U10 HD040521 / HD / NICHD NIH HHS / United States
U10 HD40521 / HD / NICHD NIH HHS / United States
U10 HD27880 / HD / NICHD NIH HHS / United States
M01 RR008084 / RR / NCRR NIH HHS / United States
U10 HD27904 / HD / NICHD NIH HHS / United States
M01 RR633 / RR / NCRR NIH HHS / United States
M01 RR2588 / RR / NCRR NIH HHS / United States
U10 HD040461 / HD / NICHD NIH HHS / United States
M01 RR016587 / RR / NCRR NIH HHS / United States
U10 HD040689 / HD / NICHD NIH HHS / United States
U10 HD040492 / HD / NICHD NIH HHS / United States
HD40689 / HD / NICHD NIH HHS / United States
U10 HD027853 / HD / NICHD NIH HHS / United States
U10 HD027904 / HD / NICHD NIH HHS / United States
U10 HD021397 / HD / NICHD NIH HHS / United States
U10 HD27856 / HD / NICHD NIH HHS / United States
U10 HD40461 / HD / NICHD NIH HHS / United States
U10 HD027871 / HD / NICHD NIH HHS / United States
U10 HD027851 / HD / NICHD NIH HHS / United States
M01 RR16587 / RR / NCRR NIH HHS / United States
U10 HD21397 / HD / NICHD NIH HHS / United States
M01 RR8084 / RR / NCRR NIH HHS / United States
U10 HD21373 / HD / NICHD NIH HHS / United States
U10 HD 27871 / HD / NICHD NIH HHS / United States
U10 HD21385 / HD / NICHD NIH HHS / United States
U10 HD034216 / HD / NICHD NIH HHS / United States
U10 HD036790 / HD / NICHD NIH HHS / United States
UL1 RR24139 / RR / NCRR NIH HHS / United States