Research ArticleOriginal Article
Open Access

Apgar values lower than 7 associated with mortality in premature newborns

A retrospective study

Nayeri Reyes-Saavedra, Patricia C. Castelán-Villagrana, Ivette Mata-Maqueda and Juan C. Solís-Sáinz
Saudi Medical Journal March 2022, 43 (3) 252-258; DOI: https://doi.org/10.15537/smj.2022.43.3.20210641

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    - Diagram of the premature newborns selection and inclusion process in the present study. SJR: San Juan del Río Hospital, PNB: premature newborns, GHSJR: General Hospital of San Juan del Río, NICU: neonatal intensive care unit.

  • Figure 2
    Figure 2

    - Correlation between: A) the 1 minute and B) 5 minutes Apgar values versus the premature newborns gestational age. A Spearman correlation was carried out for the 136 reported Apgar values. WG: weeks of gestation

  • Figure 3
    Figure 3

    - Correlation between Apgar values at A) 1 minute and B) 5 minutes versus premature newborns birth weight. A Spearman correlation was carried out for the 136 reported Apgar values. kg: kilogram

  • Figure 4
    Figure 4

    - Comparison of birth weight in premature newborns (PNB) without and with the presence of ID. A Mann-Whitney test was carried out, 62 PNB without the diagnosis of infection (median value of 2.28 kg) and 74 with a diagnosis of infections (median value of 1.88 kg) were analyzed. Median values ± interquartile ranges are shown. ID: infectious diseases

Tables

  • Table 1

    - General characteristics of the population.

    Variablen (%)
    Gender
    Male74 (54.0)
    Female62 (46.0)
    Gestational age
    Late preterm (32-37 WG)121 (89.0)
    Early preterm (28-31.6 WG)10 (7.4)
    Extremely premature (<28 WG)5 (3.6)
    Birth weight
    Suitable (>2.5 kg)32 (23.5)
    Low (1.5-2.49 kg)87 (64.0)
    Very low (1-1.49 kg)11 (8.0)
    Extremely low (<1 kg)6 (4.5)
    Apgar value (median±IR)
    At 1 minute8±0.1
    At minute 59±0.1
    Route of delivery
    Vaginal birth38 (28.0)
    Caesarean section98 (72.0)
    Maternal education
    Primary school34 (25.0)
    Middle school73 (53.6)
    High school19 (14.0)
    Bachelor’s degree10 (7.4)
    Maternal age (median±IR)26.5±3
    Days of hospital stay (median±IR)10±2
    Mothers with a history of CDD11 (8.0)
    Mothers with OGRF13 (9.5)
    PNB with respiratory diseases115 (84.5)
    PNB with infectious diseases74 (54.4)

    WG: weeks of gestation, IR: interquartile range, CDD: chronic degenerative disease, OGRF: obstetrics and gynecological risk factors (namely, previous abortion, history of preterm delivery, threatened miscarriage, and threatened preterm labor), PNB: premature newborn

    • Table 2

      - Association of risk factors with mortality in the PNB.

      VariablesDeaths (n=16)
      n (%)OR (95% CI)P-value
      Male gender9 (56.2)1.08 (0.3-3.1)0.54
      Route of delivery by caesarean section12 (75)1.1 (0.3-3.5)0.52
      Maternal education (<6 years)3 (18.7)0.6 (0.2-2.3)0.41
      Maternal age (>35 years)17 (12.5)2 (0.2-10)0.31
      Days of hospital stay (>10)10 (62.5)2.1 (0.4-10.1)0.312
      Presence of respiratory diseases15 (93.7)1.8 (0.2-14.8)0.291
      Gestational age (<32 WG)9 (56.2)24.4† (6.7-88.3)<0.0001*
      Gestational age (<28 WG)5 (31.2)54† (5.8-505)<0.0001*
      Apgar value at one minute (<7)‡13 (81.2)16.2† (3.4-76)<0.0001*
      Apgar value at 5 minutes (<7)‡7 (43.7)25.1† (6-104)<0.0001*
      Presence of infectious diseases15 (93.7)61.9† (1.1-361)0.047*
      Birth weight (<2.1 kg)§14 (87.5)8.5† (1.5-49)0.016*
      Very low birth weight (1-1.49 kg)6 (37.5)27.3† (6.8-121)0.001*
      Extremely low weight at birth (<1 kg)5 (31.2)47† (2.4-901)0.011*

      †These OR values were corrected for gender, WG, apgar values at 1 and 5 minutes, and days of hospital stay, using binary logistic regression analyses, ‡the 7 points cut-off point for the apgar value corresponds to 25th percentile, both for the 1 and 5 minutes values, §the 2.1 kg cut-off point for birth weight corresponds to the 50th percentile of this variable, *significant p-values (p<0.05), PNB: premature newborn, OR: odd ratio, CI: confidence interval, WG: weeks of gestation, kg: kilogram

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