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)
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)
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)
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.
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.