Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina.
Pediatrics. 2022 Apr 1;149(4). doi: 10.1542/peds.2021-054992.
To test the hypothesis that an Apgar score at 10 minutes is independently predictive for death or moderate or severe disability.
A secondary analysis of the Optimizing Cooling Trial (NCT01192776) including 347 infants with ≥36 weeks' gestational age at birth and hypoxic-ischemic encephalopathy and 18- to 22-month outcomes from 18 US centers in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome was the composite of death or moderate/severe disability at 18 to 22 months of age. Generalized estimating equation models were used to examine the relationship between Apgar scores and outcomes, controlling for center, hypothermia treatment, and severity of hypoxic-ischemic encephalopathy (HIE). Classification and regression tree analyses were conducted to identify combinations of variables available during resuscitation that were most predictive for the composite outcome and death.
The study revealed that 50% (13 of 26) of infants with a 10-minute Apgar score of 0 survived; 46% (6 of 13) had no disability, 16% (2 of 13) had mild disability, and 38% (5 of 13) had moderate or severe disability. The 10-minute Apgar score of 0 was independently associated with death or moderate or severe disability (adjusted relative risk = 1.72, 95% confidence interval 1.11-2.68, P value = .016), but the area under the curve analysis (AUC) was low (AUC = 0.56). The predictive accuracy improved when the 10-minute Apgar score was combined with other risk variables available during resuscitation by using a classification and regression tree analysis (AUC = 0.66).
A 10-minute Apgar score of 0 alone does not predict the risk of death or moderate or severe disability well. The current study provides evidence in support of the 2020 American Heart Association/International Liaison Committee on Resuscitation recommendation for continuing resuscitative efforts for infants who need cardiopulmonary resuscitation at 10 minutes after birth.
验证假设，即 10 分钟时的阿普加评分可独立预测死亡或中重度残疾。
这是对优化冷却试验（NCT01192776）的二次分析，共纳入 347 名胎龄≥36 周且患有缺氧缺血性脑病的婴儿，这些婴儿来自美国国立儿童健康与人类发展研究所新生儿研究网络的 18 个中心，随访时间为出生后 18 至 22 个月。主要结局为 18 至 22 个月时的死亡或中重度残疾的复合结局。使用广义估计方程模型来检验阿普加评分与结局之间的关系，控制中心、亚低温治疗和缺氧缺血性脑病（HIE）严重程度的影响。采用分类回归树分析来识别复苏期间最能预测复合结局和死亡的变量组合。
研究显示，10 分钟时阿普加评分为 0 的婴儿中，50%（26 例中的 13 例）存活；46%（13 例中的 6 例）无残疾，16%（13 例中的 2 例）为轻度残疾，38%（13 例中的 5 例）为中重度残疾。10 分钟时阿普加评分为 0 与死亡或中重度残疾独立相关（校正相对风险=1.72，95%置信区间为 1.11-2.68，P 值=0.016），但曲线下面积分析（AUC）较低（AUC=0.56）。通过分类回归树分析，将 10 分钟时阿普加评分与复苏期间其他可用的风险变量相结合，可提高预测准确性（AUC=0.66）。
10 分钟时阿普加评分为 0 并不能很好地预测死亡或中重度残疾的风险。本研究为 2020 年美国心脏协会/国际复苏联合会关于出生后 10 分钟仍需心肺复苏的婴儿应继续复苏的建议提供了证据支持。
