0404

 

APGAR SCORE AND NEONATES OF HEART DISEASE

Gao E-Y1,LU P-H2 ,  JIN H3

Shanghai First Maternity and Infant Health Hospital

Shanghai China

 

Objective: To study the relationship between Apgar score and neonate of abnormal heart disease.

 Method: 186 cases of abnormal heart, male 92 cases, female 94 cases; 128 cases of term infant, 58 cases of preterm infants; Gestation ages: 301~416; Body weight: 1090~4310g; Age: 2~32 days. The different scores of Apgar score were all recorded for 1~5 min. At the first time of birth of neonates, EKG and the congenital heart disease (CHD) were respectively divided into three groups of 0~3, 4~7, 8~10 scores of  Apgar score in the lowest scores during 1~5 min. Diagnoses of CHD confirmed by Color-Doppler-Echo(CDE) or corpus anatomy. Rectangular test P-value was used to examine the relationship between EKG or CHD and the three groups of Apgar score. The effect of single component Apgar score assessed neonatal heart disease. Apgar scores of single component was respectively recorded in Apgar score of 1~7 scores groups, including heart rate, respiratory effort, muscle tone, reflectivity, color.

Result: There is no marked significance in the difference between normal and abnormal of EKG among the three groups of Apgar score. (X2=2.245, P=0.325). There is no marked significance in the difference between survival and mortality of CHD among the three groups of Apgar score. (X2=3.858, P=0.145). Apgar score of single component scores was the highest with heart rate of 100%; following with reflex activity of 81.5%; muscle tone of 66.6%; respiratory effort of 62.5%; the poorest with color of 58.4%.

Conclusion: There is limitation of Apgar score for the evaluation of abnormal heart in the neonates at the first birth. Although the Apgar score for single component of heart rate is up to 100%, the group test can not indicate neonatal cardiac condition.

Key words: Apgar score   Neonate    Heart disease

 

SESSION TITLES for the 2nd International Congress on Pediatric Nursing

 

 

 

LECTURE OR FOR POSTER

APGAR SCORE AND NEONATES OF HEART DISEASE

Gao E-Y1, LU P-H2, JIN H3

Shanghai First Maternity and Infant Health Hospital

Shanghai China


METHOD

l         The pediatrics doctor, midwife and maternity doctor did the evaluation of Apgar score.

l         The different scores of Apgar score were all recorded for 1~5 min. At the first time of birth of neonates.

l         EKG and CHD were respectively divided into three groups of 0~3, 4~7, 8~10 scores of Apgar score in the lowest scores during 1~5 min.

l         Rectangular test P-value was used to examine the relationship between EKG or CHD and the three groups of Apgar score.

l         The effect of single component Apgar score assessed neonatal heart disease. Apgar score of single component was analyzed in Apgar score of 1~7 scores groups, including heart rate, respiratory effort, muscle tone, reflectivity, color.

 

 

RESULT

Comparison of Apgar score and EKG (Table 1)

 

Table 1

        Apgar score       n (cases)                              EKG

         (Scores)                                          normal         abnormal

         0~3               16                                 4                  12

         4~7               19                                 2                  17

         8~10             86                                10                 76

       x2=2.245          p=0.325

For the Apgar score of the neonates, there is no marked significance in the difference between the normality and abnormality among 3 groups of Apgar score. (P>0.05)

 

 

 

The relationship between Apgar score and the outcome of CHD in the neonates.(table2)

 

Table 2

             Apgar score     n (cases)                                     CHD

 (Scores)                                       Survival (%)           Mortality (%)

0~3                    8                            4 (50)                       4 (50)

4~7                  10                            6 (60)                       4 (40)

8~10                80                          62 (77.5)                  18 (22.5)

x2=3.858         p=0.145

 For the Apgar score of the neonates, there is no marked significance in the difference between survival and mortality of CHD among the 3 groups of Apgar score (p>0.05)


The distribution of Apgar score for different components.(table3)

Table 3

  Apgar score       n          heart rate         respiration        tone       reflection         color

   (Scores)       (Cases)

1                5              1´5*                    0                   0               0                   0

2                8              1´8                     0                 1´2           1´6                 0

3                5              1´5                   1´2               1´2           1´5               1´1

4                6              1´4                   1´4               1´4           1´5               1´3

                                  2´2

5             18              1´18                  1´18             1´18         1´18             1´18

6               4              1´1                   1´4                1´4           1´3               1´4

                                 2´3

7              2               2´2                   1´2                1´2           1´1               1´1

                                                           2´1                2´1

                                 1´41                 1´30              1´32         1´38             1´27

              48              (85.4)                (62.5)             (66.6)       (77.2)          (56.3)

Total     (%)              2´7                                                           2´2              2´1

                                (14.6)                                                        (4.3)            (2.15)

*Apgar score´No. of case

  The single component of heart rate is up to 100%, the next is reflex activity 81.5%; muscle tone 66.6%; respiratory effort 62.5%; the poorest is color 58.4% in the 1~7 scores groups of Apgar score.

 

DISCUSSION

l        Apgar score has some limitations for neonatal heart disease. Apgar score of heartbeat cannot confirm the heart damage of neonatal caused from amoxia and ischemia (see table1) or CHD (see table2). However, the single component of heart rate of Apgar score is up to 100%. (See table3).

l        In fact CHD is serious, but the heart compensation ability still exists, after birth during the preliminary several hours. For the total of 98 cases of CHD group, Apgar score³8 scores accounting for 81.6% (80/98); in the 80 cases, 18 cases of mortality accounting for 22.5%(18/80)(see table2). There are 3 cases of the neonates who were crying with the cyanotic when they were taking bath in the second day after birth. The nurse urgently sent the babies to NICU for further inspection and they were confirmed as CHD.

l        It is possible as early diagnosis as for the neonates with serious CHD.  Pediatrics doctor can grab the best chance for the operation treatment and decreased the mortality of perinatal infants.

l        Owing to the misguiding of the limitation of Apgar score evaluation, it often arises the dispute concerning the medical cure. It is necessary to suggest that the pediatrics doctor obtain the following information of the abnormal neonates as quickly as possible: blood-gas analysis, EKG, CDE, serum of cardiac trponin value with the evidence of diagnosis so as to raise the quality and level of medical treatment of the perinatal infants.

ARTICLE

APGAR SCORE AND NEONATES OF HEART DISEASED

Gao E-Y1,  LU P-H2 ,  JIN H3

Shanghai First Maternity and Infant Health Hospital

Shanghai China

Objective: To study the relationship between Apgar score and neonate of abnormal heart disease.

 Method 186 cases of abnormal heart, male 92 cases, female 94 cases; 128 cases of term infant, 58 cases of preterm infants; Gestation ages: 301~416; Body weight: 1090~4310g; Age: 2~32 days. The different scores of Apgar score were all recorded for 1~5 min. At the first time of birth of neonates, EKG and the congenital heart disease (CHD) were respectively divided into three groups of 0~3, 4~7, 8~10 scores of   Apgar score in the lowest scores during 1~5 min. Diagnoses of CHD confirmed by Color-Doppler-Echo(CDE) or corpus anatomy. Rectangular test P-value was used to examine the relationship between EKG or CHD and the three groups of Apgar score. The effect of single component Apgar score assessed neonatal heart disease. Apgar scores of single component was respectively recorded in Apgar score of 1~7 scores groups, including heart rate, respiratory effort, muscle tone, reflectivity, color.

Result There is no marked significance in the difference between normal and abnormal of EKG among the three groups of Apgar score. (X2=2.245, P=0.325). There is no marked significance in the difference between survival and mortality of CHD among the three groups of Apgar score. (X2=3.858, P=0.145). Apgar score of single component scores was the highest with heart rate of 100%; following with reflex activity of 81.5%; muscle tone of 66.6%; respiratory effort of 62.5%; the poorest with color of 58.4%.

Conclusion There is limitation of Apgar score for the evaluation of abnormal heart in the neonates at the first birth. Although the Apgar score for single component of heart rate is up to 100%, the group test can not indicate neonatal cardiac condition.

Key words: Apgar score   Neonate    Heart disease

 

 

  In the lately century, medical doctors of pediatrics, maternity and midwife have used Apgar score to assess newborn infants on their hraet rate, respiratory effort, muscle tone, reflex activity and color. They observed several clinical signs simultaneously in making clinical decisions and assisted in the establishment of standard policies for resuscitation. The Apgar score continues to be used as the best eastablishment index of immediate postnatal health at the first time of birth infants.

  In the review and summary from the clinical information for many years, Apgar score is not applicable for the neonates with heart abnormality. In this paper we reported the relationship between the Apgar score and 186 cases of neonates with heart abnormality as follows:

1.      Object and method

1.1    object: from February, 1995 to December, 1998, the NICU and the Center for Bringing Up of Preterm Infants had accepted for treatment of  186 cases of neonates with heart abnormality, male 92 cases, female 94 cases; postnate 128 cases, preterm infant 58 cases; Gestation 301~416; body weight 1090~4310g; age 2~32 days.

1.2     Method

1.2.1        Instrument: Employing US-made ATL-9 Color-Doppler-Echo(CDE), probe frequency 5.0 mHz; homemade ECG-6511, 30 VA electrocardiogram(EKG).

1.2.2        EKG abnormality: low voltage, ventricular hypertrophy; abnormal wave; Q wave, ST wave, Q-T intermittent change, U wave high, steep and shap; heart rate/rhythm change; heart rate too fast or too slow, arrhythmia.

1.2.3        Color-Doppler-Echo or corpus anatomy for the diagnosis of the congenital cardiovascular defects (CHD for brief) including ASD, VSD, PDA, TGA, PS, TOF, PA, TAS, DORV, tricuspid downward shift, tunic pad damage common passage,  Egg-round aperture unclosed.

1.2.4        The evaluation of Apgar scor was done by the medical personnel participating the parturient of the neonates including pediatrics doctor, midwife and maternity doctor.

     They assessed the total Apgar scores of the neonates with heart abnormality after child birth 1~5min, took the lowest scores and divided into 3 groups of 0~3, 4~7, 8~10 scores of Apgar score. To compare the three groups of Apgar score with the relationship of EKG abnormality and outcome of CHD. The total scores of Apgar score were evaluated for 1~7 scores groups and were worked out the distribution rate for the scores of different components of heart rate, respiratory effort, muscle tone, reflex activity and color.

2.      Result

2.1    COMPARISON OF Apgar score and EKG(Table 1)

Table 1

        Apgar score       n (case)                               EKG

         (score)                                              normal         abnormal

         0~3                   16                               4                  12

         4~7                   19                               2                  17

         8~10                 86                             10                  76

       x2=2.245          p=0.325

For the Apgar score of the neonates, there is no marked significance in the difference between the normality and abnormality among 3 groups of Apgar score.(p>0.05)

2.2    The relationship between Apgar score and the outcome of CHD in the nenates.(table2)

Table 2

Apgar score     n (case)                      Congenital heart diseae

 (score)                                       Survival (%)            Mortality (%)

    0~3                   8                       4 (50)                         4 (50)

    4~7                 10                       6 (60)                         4 (40)

    8~10               80                     62 (77.5)                    18 (22.5)

x2=3.858         p=0.145

      For the Apgar score of the neonates, there is no marked significance significance in the difference between survival and mortality of CHD among the 3 groups of Apgar score (p>0.05)

2.3    The distribution of Apgar score for different components.(table3)

Table 3

  Apgar score          n           heart rate        respiration     tone      reflection       color

      (score)          (case)

1                   5               1´5*                   0               0                0                 0

2                   8               1´8                    0             1´2            1´6               0

3                   5               1´5                  1´2           1´2            1´5             1´1

4                   6               1´4                  1´4           1´4            1´5             1´3

                                      2´2

5                 18              1´18                 1´18         1´18          1´18           1´18

6                   4              1´1                   1´4           1´4            1´3             1´4

                                     2´3

7                   2              2´2                   1´2           1´2            1´1             1´1

                                                                                                  2´1             2´1

                                      1´41                 1´30        1´32           1´38           1´27

                   48              (85.4)                (62.5)       (66.6)         (77.2)         (56.3)

Total          (%)              2´7                                                      2´2             2´1

                                     (14.6)                                                   (4.3)            (2.15)

*Apgar score´No. of case

  The single component of heart rate is up to 100%, the next is reflex activity 81.5%; muscle tone 66.6%; respiratory effort 62.5%; the poorest is color 58.4% in the 1~7 scores groups of Apgar score.

3.      Discussion

3.1    Apgar score has been widely applied in the determination whether or not the neonates require resuscitation at the first time of child birth and forecast of transformation and evaluation of the change condition of the neonates after several minutes of child birth. In this pager, the Apgar score used to evaluate neonates the emergency cure and forecast the prognosis. However, it has the following limitations:

3.1.1        Health beat is the first characteristics of the life of human body. After several minutes of child birth, although the score for the single component of heart rate is the highest among the different components (see table3), as for many reasons, the heart damage of the neonates caused from anoxia and ischemia, indicated the physiological change of the electrocardio condition of the diseased infant EKG but the heart beat remains active and there is no way to ascertain the disease of heart.(see table 1)

3.1.2        Oxygen supply is helped by the mother body within the utexus for CHD of the neonates. The heart of fetus itself also exists overloaded compensation (EKG, radioscope indicate ventricular hypertrophy). In fact  CHD is serious, the heart compensation ability still exists. The only way to give the evaluation of the component of heart rate is diffcult to evaluate the danger of the hidden threat to life due to the cardiovascular defect of the diseased infant. For the total of 98 cases of CHD group, Apgar score³8 scores accounting for 81.6% (80/98); in the 80 cases, 18 cases of mortality accounting for 22.5%(18/80)(see table 2). There are 3 cases of the neonates who were crying with the cyanotic when they were taking bath in the second day after birth. The nurse urgently sent the babies to NICU for further inspection and they were confirmed as CHD.

3.2    It is possible as early diagnosis as for the neonates with serious CHD.

Pediatrics doctor can grab the best chance for the operation treatment and decreased the mortality of perinatal infants.

 3.3 The life of neonates are feeble and the situation of change of sickness is very fast.          Owing to the misguiding of the limitation of Apgar score evaluation, it often arises the dispute concerning the medical care. It is therefore necessary to suggest that the pediatrics doctor obtain the following information of  the abnormale neonates as quickly as possible: blood-gas analysis, EKG, CDE, serum of cardiac trponin value with the evidence of diagnosis so as to raise the quality and level of medical treament of the perinatal infants.