Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study.

BACKGROUND: The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil. METHODS: This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed. RESULTS: After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60-6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19-0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU. CONCLUSION: In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.

Síndrome metabólica / Metabolic syndrome

A resistência à insulina evidencia a importância biológica deste hormônio. Nos estágios mais precoces de resistência há aumento compensatório das concentraçöes de insulina circulantes. Entretanto, a hiperinsulina, da mesma forma que procura compensar a deficiência relativa desse hormônio, também resulta numa açäo excessiva nos tecidos que mantém sensibilidade normal ou levemente alterada à insulina. Assim, a desproporçäo de açäo entre tecidos mais e menos sensíveis à insulina determina diversas manifestaçöes clínicas e doenças, tais como Diabetes mellitus, hipertensäo e doenças cardiovasculares. As consequências existentes, em termos de saúde pública, säo enormes, o que justifica os esforços que visem a diminuir ou acabar com os fatores de risco para a populaçäo.