Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
PLoS One. 2013 Jul 29;8(7):e69072. doi: 10.1371/journal.pone.0069072. Print 2013.
To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period.
The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores.
Among births with a very low Apgar score at five minutes (1-3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births.
The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.
评估阿普加评分在广泛应用 50 多年后是否仍然适用于当代实践，并评估阿普加评分在预测婴儿存活率方面的价值，从新生儿扩展到新生儿后期。
使用了美国链接的活产和婴儿死亡数据集，其中包括 25168052 例单胎分娩和 768305 例双胎分娩。感兴趣的结局是出生后 1 年内婴儿死亡。使用 Cox 比例风险模型估计不同阿普加评分的婴儿死亡率的风险比。
在 5 分钟时阿普加评分非常低（1-3）的分娩中，新生儿和新生儿后期的死亡率在足月（≥37 周）前仍然很高。另一方面，在阿普加评分较高（≥7）的分娩中，新生儿和新生儿后期的死亡率随着胎龄的增加而逐渐下降。非西班牙裔白人在早产儿和足月儿中新生儿死亡率均始终高于非西班牙裔黑人。然而，对于新生儿后期死亡率，黑人的死亡率明显高于白人。双胞胎和单胎出生中，阿普加评分与新生儿和新生儿后期死亡率之间的变化模式基本相同。
阿普加评分系统在预测足月和早产儿的新生儿和新生儿后期不良结局方面具有持续的价值，适用于双胞胎和不同种族/族裔群体。
