Department of Pediatrics, Wayne State University, , Detroit, Michigan, USA.
Arch Dis Child Fetal Neonatal Ed. 2013 Nov;98(6):F473-9. doi: 10.1136/archdischild-2013-303692. Epub 2013 Jul 29.
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).
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.
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).
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.
确定纳入国立儿童健康与人类发展研究所新生儿研究网络（NICHD NRN）全身冷却随机对照试验（RCT）的围产期缺氧缺血性脑病（HIE）患儿 10 分钟 Apgar 评分与 6-7 岁结局的相关性。
6-7 岁的评估包括韦氏学龄前和小学智力量表 III 或韦氏儿童智力量表 IV 和粗大运动功能分类量表。主要结局为死亡/中度或重度残疾。使用逻辑回归检验调整出生体重、胎龄、性别、出生地点、低温治疗和中心后 10 分钟 Apgar 评分与结局的相关性。
在研究队列中（n=174），10 分钟 Apgar 评分为 0-3 的患儿中有 64/85（75%）死亡/残疾，而评分为>3 的患儿中有 40/89（45%）死亡/残疾。10 分钟 Apgar 评分每增加 1 分，调整后的死亡/残疾、死亡、死亡/智商<70、死亡/脑瘫（CP）和残疾、智商<70 和幸存者 CP 的风险显著降低（所有 p<0.05）。在 10 分钟 Apgar 评分为 0 的 24 名儿童中，5 名（20.8%）无残疾存活。Apgar 评分为 0-3 的冷却婴儿的死亡/残疾风险调整后显著降低；冷却与 Apgar 评分之间无显著交互作用（p=0.26）。
在纳入 NICHD 冷却 RCT 的围产期 HIE 患儿中，10 分钟 Apgar 评分与学龄期结局显著相关。10 分钟 Apgar 评分为 0 的婴儿中有五分之一无残疾存活至学龄期，这表明需要谨慎限制复苏时间。
