Bhagwani Dalip Kumar, Sharma Manisha, Dolker Stanzin, Kothapalli Sharada
Senior Pediatrician, Department of Paediatrics, Hindu Rao Hospital , Delhi, India .
Senior Specialist, Department of Obstetrics and Gynaecology, Hindu Rao Hospital , Delhi, India .
J Clin Diagn Res. 2016 Nov;10(11):SC16-SC19. doi: 10.7860/JCDR/2016/22896.8882. Epub 2016 Nov 1.
Throughout the world each year, an estimated 23% of the 4 million neonatal deaths and 8% of all deaths in <5 years of age are associated with signs of asphyxia at birth.
To study the role of cord arterial blood gas analysis at birth and serial Thompson score in predicting the early neonatal outcome in post asphyxiated term neonates.
The study was conducted in Department of Paediatrics, in Neonatal Intensive Care Unit (NICU), Hindu Rao Hospital, New Delhi from May 2014 to February. 2015. This study was a prospective cross-sectional study. During this period, a total of 145 post asphyxiated term neonates born in labour room/obstetric operation theatre were recruited. An informed consent was taken from all the parents. The protocol was approved by the institutional ethical committee. Inclusion criteria were full-term babies with low-Apgar score i.e., 1 min score of ≤ 7 National Neonatal Perinatal Database 2010 (NNPD 2010).
SPSS 17.0 Software has been used for data analysis. The data were expressed in terms of Means, Standard Deviation and Proportion, followed by comparison between groups through chi-square test or Fisher's-exact test. A p-value of less than 0.05 was considered as statistically significant.
The present study was carried out on 145 post asphyxiated full-term babies with low-Apgar score i.e., 1min score of ≤7mild Thompson score on day I,2,3 were 96 (66.2%), 119 (82.06%), 125 (86.20%), moderate Thompson score on day 1,3, 7 were 13 (8.9%), 6 (4.13%), 2 (1.37%) and severe Thompson score on day 1, 3, 7 were 36 (24.8%), 13 (8.96%), 7 (4.82%) respectively. Total 11 patients died out of 145 post asphyxiated full-term babies within 7 days, among 11 patients, 7 died within 3 days. There was clinical improvement among HIE patients as indicated by serial Thompson score done on day 1, 3 and 7. Among 145 patients 62(42.8%) had seizure and 83(57.2%) did not have seizure. Most common type of seizure was subtle seizure in 25 (40.3%) followed by multifocal in 21 (33.9%) and tonic in 16(25.8%).
There is statistically significant correlation between morbidity and day 1 Thompson score (p-value 0.024). There is statistically significant correlation between mortality and day 1 Thompson score (p-value 0.001). Thompson score allows a very precise description of infants by assigning a numeric score rather than 'mild', 'moderate' or 'severe'. Inter-rater reliability is very good with a kappa co-efficient of 0.87.
在全球范围内，每年估计400万例新生儿死亡中的23%以及5岁以下儿童所有死亡中的8%与出生时的窒息迹象有关。
研究出生时脐动脉血气分析及连续汤普森评分在预测窒息足月新生儿早期新生儿结局中的作用。
本研究于2014年5月至2015年2月在新德里印度教饶医院新生儿重症监护病房（NICU）的儿科进行。本研究为前瞻性横断面研究。在此期间，共招募了145例在产房/产科手术室出生的窒息足月新生儿。获得了所有家长的知情同意。该方案得到了机构伦理委员会的批准。纳入标准为低Apgar评分的足月婴儿，即1分钟评分≤7（2010年国家新生儿围产期数据库）。
采用SPSS 17.0软件进行数据分析。数据以均值、标准差和比例表示，随后通过卡方检验或费舍尔精确检验进行组间比较。p值小于0.05被认为具有统计学意义。
本研究对145例低Apgar评分（即1分钟评分≤7）的窒息足月婴儿进行。第1天、第2天、第3天轻度汤普森评分分别为96例（66.2%）、119例（82.06%）、125例（86.20%）；第1天、第3天、第7天中度汤普森评分分别为13例（8.9%）、6例（4.13%）、2例（1.37%）；第1天、第3天、第7天重度汤普森评分分别为36例（24.8%）、13例（8.96%）、7例（4.82%）。145例窒息足月婴儿中有11例在7天内死亡，其中11例中有7例在3天内死亡。第1天、第3天和第7天进行的连续汤普森评分表明，HIE患者有临床改善。145例患者中，62例（42.8%）有惊厥，83例（57.2%）无惊厥。最常见的惊厥类型为细微惊厥25例（40.3%），其次为多灶性惊厥为21例（33.9%），强直性惊厥为16例（25.8%）。
发病率与第1天汤普森评分之间存在统计学显著相关性（p值0.024）。死亡率与第1天汤普森评分之间存在统计学显著相关性（p值0.001）。汤普森评分通过赋予数字评分而非“轻度”、“中度”或“重度”，能够对婴儿进行非常精确的描述。评分者间信度非常好，kappa系数为（0.87）。
