Khorram Bita, Kilmartin Keira C, Dahan Maya, Zhong You Jia, Abdelmageed Wael, Wintermark Pia, Shah Prakesh S
Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Neonatology, McGill University Health Centre, Montreal, Québec, Canada.
Neonatology. 2022;119(6):669-685. doi: 10.1159/000525926. Epub 2022 Aug 31.
The Apgar score is a standardized method of assessing the primary adaptation and clinical status of a neonate after birth. Our objective was to systematically review and meta-analyze the survival and the survival without moderate-to-severe neurodevelopmental impairment (NDI) of neonates with a 10-min Apgar score of zero.
Six electronic databases were searched for reports published until November 2021 of neonates with a 10-min Apgar score of zero. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case series/reports. Meta-analyses of the proportion of outcomes were conducted using a random-effects model for studies published after year 2000 and reporting >5 neonates. Meta-regression using the median year of the study period and subgroup analyses by treatment with therapeutic hypothermia and by gestational age were conducted.
Twenty-eight studies of 820 neonates with moderate risk of bias were included. Survival was 40% (95% confidence interval 30-50%, 16 studies, 646 neonates, I2 = 83%), and it increased by 2.3% per year (95% CI 1.3-3.2%, p < 0.001). Survival without moderate-to-severe NDI was 19% (95% confidence interval 11-27%, 13 studies, 211 neonates, I2 = 62%). Survival was higher for neonates who received therapeutic hypothermia and for those with a gestational age ≥32 weeks compared to <32 weeks.
Approximately 2 in 5 neonates with a 10-min Apgar score of zero survived, and 1 in 5 survive without moderate-to-severe NDI survived. Survival has improved over the years, especially since the era of therapeutic hypothermia.
阿氏评分是评估新生儿出生后初步适应情况和临床状态的标准化方法。我们的目的是系统评价并荟萃分析10分钟阿氏评分为零的新生儿的生存情况以及无中度至重度神经发育障碍（NDI）的生存情况。
检索六个电子数据库，查找截至2021年11月发表的关于10分钟阿氏评分为零的新生儿的报告。使用纽卡斯尔-渥太华队列研究量表和乔安娜·布里格斯研究所病例系列/报告关键评价清单评估偏倚风险。对2000年后发表且报告新生儿数>5例的研究，采用随机效应模型对结局比例进行荟萃分析。使用研究期的中位数年份进行荟萃回归，并按治疗性低温治疗和胎龄进行亚组分析。
纳入了28项对820例新生儿的研究，这些研究存在中度偏倚风险。生存率为40%（95%置信区间30 - 50%，16项研究，646例新生儿，I² = 83%），且每年增加2.3%（95% CI 1.3 - 3.2%，p < 0.001）。无中度至重度NDI的生存率为19%（95%置信区间11 - 27%，13项研究，211例新生儿，I² = 62%）。与胎龄<32周的新生儿相比，接受治疗性低温治疗的新生儿以及胎龄≥32周的新生儿生存率更高。
10分钟阿氏评分为零的新生儿中，约五分之二存活，五分之一存活且无中度至重度NDI。多年来生存率有所提高，尤其是自治疗性低温时代以来。
