Lai Shimona, Flatley Christopher, Kumar Sailesh
Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia.
Mater Research Institute - University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland, QLD 4101, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:251-256. doi: 10.1016/j.ejogrb.2017.01.008. Epub 2017 Jan 6.
To evaluate the specific maternal and perinatal variables associated with a low (≤3) or moderate (4-6) Apgar score, compared to a high (≥7) score.
This was a retrospective, cohort study of 58429 term singleton babies born at the Mater Mother's Hospital in Brisbane, Australia in 2007-2013. Maternal demographics, socio-economic status using the Australian Socioeconomic Index for Areas (SEIFA) score, obstetric factors, and birth outcomes were compared for neonates grouped into three categories based on their five-minute Apgar: low (≤3), moderate (4-6) and high (≥7). The low- and moderate-score cohorts were individually compared to the high-score cohort using both univariate and multivariate analysis.
Logistic regression analysis confirmed that of the variables analysed, only maternal public insurance status (OR 2.1, 95% CI 1.5-3.1), breech presentation (OR 2.4, 95% CI 1.1-4.6), other non-cephalic presentation (OR 9.5, 95% CI 2.2-25.4), intramuscular narcotic use (OR 2.3, 95% CI 1.5-3.5), and presence of meconium (OR 3.7, 95% CI 2.5-5.4) were significantly associated with low Apgar scores. Variables significantly associated with a moderate score were: SEIFA ≤50th centile (OR 1.6, 95% CI 1.2-2.0) and 61st to 70th centile (OR 1.31, 95% CI 0.9-1.8) categories, maternal public insurance status (OR 2.7, 95% CI 2.2-3.3), nulliparity (OR 2.0, 95% CI 1.7-2.5), emergency caesarean birth (OR 2.6, 95% CI 2.1-3.2), instrumental birth (OR 2.3, 95% CI 1.9-2.9), and presence of meconium (OR 2.6, 95% CI 2.1-3.2).
Factors associated with low and moderate Apgar scores vary in type and degree of influence. Distinctions in the perinatal background can help predict newborn compromise and accelerate delivery of care.
评估与低（≤3）或中等（4 - 6）Apgar评分相关的特定孕产妇和围产期变量，并与高（≥7）评分进行比较。
这是一项回顾性队列研究，研究对象为2007年至2013年在澳大利亚布里斯班母亲医院出生的58429例足月单胎婴儿。根据新生儿5分钟Apgar评分将其分为三类：低（≤3）、中等（4 - 6）和高（≥7），比较了孕产妇人口统计学特征、使用澳大利亚地区社会经济指数（SEIFA）评分的社会经济状况、产科因素及出生结局。采用单因素和多因素分析，将低评分和中等评分队列分别与高评分队列进行比较。
逻辑回归分析证实，在所分析的变量中，只有孕产妇公共保险状态（比值比[OR] 2.1，95%置信区间[CI] 1.5 - 3.1）、臀位分娩（OR 2.4，95% CI 1.1 - 4.6）、其他非头位分娩（OR 9.5，95% CI 2.2 - 25.4）、肌肉注射麻醉剂使用（OR 2.3，95% CI 1.5 - 3.5）和胎粪存在（OR 3.7，95% CI 2.5 - 5.4）与低Apgar评分显著相关。与中等评分显著相关的变量有：SEIFA≤第50百分位数（OR 1.6，95% CI 1.2 - 2.0）和第61至70百分位数（OR 1.31，95% CI 0.9 - 1.8）类别、孕产妇公共保险状态（OR 2.7，95% CI 2.2 - 3.3）、初产（OR 2.0，95% CI 1.7 - 2.5）、急诊剖宫产（OR 2.6，95% CI 2.1 - 3.2）、器械助产（OR 2.3，95% CI 1.9 - 2.9）和胎粪存在（OR 2.6，95% CI 2.1 - 3.2）。
与低和中等Apgar评分相关的因素在类型和影响程度上有所不同。围产期背景的差异有助于预测新生儿健康问题并加速护理的提供。
