Hypoxic-ischemic encephalopathy and the Apgar scoring system: The experience in a resource-limited setting

Abstract

Introduction: Virginia Apgar developed the Apgar scoring which has shown relevance in assessing the general well-being of the newborn at delivery and also determining the response and effectiveness of resuscitation. This includes the 1st, 5th, and even the 10th and 20th min scores. However, the first and fifth scores have been severally used in defining perinatal asphyxia. This study, therefore, seeks to assess the performance of Apgar scoring in a resource-limited setting in determining hypoxic-ischemic encephalopathy (HIE). Materials and Methods: This was a retrospective study. The medical records of 142 admitted newborns with a diagnosis of perinatal asphyxia were reviewed over a 1-year period. Results: There were 86 males and 56 females with perinatal asphyxia and a male-to-female ratio of 1.5:1. Most cases had a 1 min Apgar score in the range of 4–5 (62.0%), whereas using the 5th min Apgar score, majority of the cases had scores of 6 and more. Sixty-five cases (45.8%) had HIE, whereas Stage 1 HIE was the most recorded form of encephalopathy. The 1st min Apgar scoring showed that most cases with a score of 4–5 had Stage 1 HIE, whereas all the nine cases with Stage 3 HIE had a score of 0–3 (Fisher's exact test = 132.074; P = 0.00); furthermore, most cases with Stage 1 HIE had a 5 min score of 6 and above, but all the cases with Stage 3 HIE had a score between 4 and 5 (Fisher's exact test = 49.024; P = 0.00). Conclusion: The Apgar score still remains an important tool in neonatal resuscitation and monitoring; asphyxiated neonates need to be actively and effectively resuscitated.

Keywords

• Apgar score
• birth asphyxia
• hypoxic-ischemic encephalopathy
• resource-limited setting