Comparison of Combined Apgar Score and Umbilical Cord Arterial Blood Gas in Prediction of Poor Short Term Outcomes in Neonates

Abstract

Background: The APGAR scoring system, including conventional, expanded, and combined Apgar scores, has been used to evaluate the condition of the newborn in the first minutes of birth. Umbilical cord arterial blood gas analysis (UCABGA) is another method. We compared the combined Apgar score with UCABGA in predicting short-term outcomes in neonates. Methods: A prospective cohort study was conducted on 363 live births. Neonates with major congenital anomalies, congenital cyanotic heart disease, congenital metabolic disorders, and those who transferred to other hospitals were excluded. Admission, discharge, demographic data, and Apgar scores were recorded in a pre-designed form. After delivery, the umbilical cord was double-clamped, and an arterial blood sample was taken from the clamped part. Statistical analyses were done using SPSS version 22 statistical software, and the receiver operating characteristic (ROC) curve was used to analyze the correlations between variables. Results: Out of 350 Neonates (204 male and 146 female) with a mean gestational age of 33.37±4.12 weeks, 263 (75.1%) neonates were admitted, and 34 neonates (9.7%) died. Retinopathy of prematurity(ROP) and Intraventricular hemorrhage (IVH) were recognized in 42 (12%) and 54 (15.4%) neonates, respectively, and 37 ( 10.6%) neonates ventilated mechanically. ROC curves show higher sensitivity and Specificity of 5th minute Combined Apgar score than PH and base deficit in predicting short-term outcomes except for IVH. Conclusion: The Combined Apgar score at minute 5 is a better predictor than UCABGA in predicting Death, need for admission, retinopathy of prematurity, and need for mechanical ventilation. None are good predictors for IVH.

Keywords

• apgar score
• blood gas
• umbilical cord