School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Lancet. 2014 Nov 15;384(9956):1749-55. doi: 10.1016/S0140-6736(14)61135-1. Epub 2014 Sep 15.
The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes.
We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0-3) and intermediate (4-6) Apgar scores at 5 min referent to neonates with normal Apgar score (7-10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed.
Complete data were available for 1,029,207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7-10) was strongest at term (p<0·0001). A low Apgar (0-3) was associated with an adjusted RR of 359·4 (95% CI 277·3-465·9) for early neonatal death, 30·5 (18·0-51·6) for late neonatal death, and 50·2 (42·8-59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4-6). The strongest associations were for deaths attributed to anoxia and low Apgar (0-3) for term infants (RR 961·7, 95% CI 681·3-1357·5) and preterm infants (141·7, 90·1-222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1-4·6 at term; 1·2, 0·3-4·8 at preterm).
Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice.
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阿普加评分作为一种评估新生儿早期状况的指标，已经在全球范围内使用了 60 多年。随着医疗保健服务的进步、新生儿复苏和婴儿护理的发展，其目前的相关性尚不清楚。本研究旨在确定 5 分钟时的阿普加评分与新生儿和婴儿死亡风险之间的关系强度，并按特定原因进行细分。
我们将英国苏格兰 1992 年至 2010 年期间所有分娩的常规出院和死亡率数据进行了关联。我们将分析仅限于单胎活产、母亲年龄大于 10 岁、分娩时孕周在 22 至 44 周之间的婴儿，并排除因先天性异常或同种免疫导致的死亡。我们使用二项式对数线性模型计算了 5 分钟时低（0-3）和中（4-6）阿普加评分新生儿与正常阿普加评分（7-10）新生儿的新生儿和婴儿死亡的相对风险（RR），并对混杂因素进行了调整。由于胎龄是一个显著的效应修饰因素，因此按胎龄进行了分层分析。缺失的协变量数据通过插补进行了处理。
共有 1029207 例符合条件的活产儿完整数据可用。在所有胎龄组中，5 分钟时的低阿普加评分与新生儿和婴儿死亡风险增加相关。然而，这种关联的强度（调整后的 RR，95%CI 参照阿普加评分为 7-10）在足月时最强（p<0·0001）。低阿普加评分（0-3）与早期新生儿死亡的调整后 RR 为 359.4（95%CI 277.3-465.9）、晚期新生儿死亡的 RR 为 30.5（18.0-51.6）和婴儿死亡的 RR 为 50.2（42.8-59.0）相关。我们注意到，中阿普加评分（4-6）的关联强度较低。对于足月婴儿（RR 961.7，95%CI 681.3-1357.5）和早产儿（RR 141.7，90.1-222.8），与低氧血症和低阿普加评分（0-3）相关的死亡的关联最强。在任何胎龄（足月 RR 0.6，95%CI 0.1-4.6；早产 RR 1.2，0.3-4.8）均未观察到 5 分钟时的阿普加评分与婴儿猝死综合征风险之间的关联。
5 分钟时的低阿普加评分与新生儿和婴儿死亡风险密切相关。我们的研究结果支持其在当代实践中的继续使用。
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