The relationship between the low Apgar scores of the newborns and hematologic parameters which are inflammatory markers

Abstract

Objective: To investigate the relationship between the 5-minute Apgar scores of the newborns checked in the cases induced due to prolonged pregnancy and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and to investigate the contributions of these parameters as prognostic markers in the low Apgar scores. Methods: A total of 169 primigravida cases for which delivery by induction was decided due to prolonged pregnancy after they completed 41 weeks of gestation between 2017 and 2018 were included in the study. The detailed previous histories of all cases were obtained at admission and they underwent cervicovaginal examination, obstetric ultrasonography for the assessment of fetal biometry and amniotic fluid, and complete blood count including hemoglobin level, total white blood cell count, differential leukocyte number and platelet count. NLR and PLR were calculated as the ratio of neutrophil number to lymphocyte number and the ratio of platelet number to lymphocyte number, respectively. The Apgar scores in the newborn assessment were determined according to the usual criteria 1 and 5 minutes after the birth. The independent samples t-test, Mann-Whitney U test and chi-square test were used for the analysis of the data. Results: The mean NLR and PLR values of the cases were calculated 4.8±2.8 and 148.8±74.9, respectively. While 108 (64%) patients delivered vaginally, 61 (36%) patients delivered by cesarean section. The Apgar score was >7 in 142 (84%) patients and <7 in 27 (16%) patients. NLR and PLR values were significantly higher in the group with Apgar score <7 than the group with Apgar score ≥7 (p<0.05). Conclusion: The elevations in NLR and PLR is the usual part of a health pregnancy; however, excessively elevated inflammation has been associated with poor prenatal and developmental outcomes in various populations. In conclusion, these markers can be used as the parameters helping clinicians to predict poor obstetric outcomes.