Association between Liver and Kidney Function and Birth Outcomes in Pregnant Surinamese Women Exposed to Mercury and Lead in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Environmental Epidemiologic Cohort Study.

Exposure to mercury (Hg) and lead (Pb), in combination with liver and kidney impairment, may result in adverse birth outcomes. From 408 women in the age range of 16 to 46 years, living in rural and urban areas in the interior of Suriname, we looked at the association between adverse birth outcomes and exposure to Hg and Pb in combination with liver and kidney function. This group of women represented a subcohort of pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH)-Meki Tamara study. Liver function was assessed by measuring aspartate amino transferase (AST), alanine amino transferase (ALT), and gamma-glutamyl transferase (GGT). Kidney function was assessed by measuring creatinine, urea, and cystatin C. We defined preterm births as birth before 37 weeks of gestation, low birthweight as birthweight < 2500 g, and low Apgar score as a score < 7 at 5 min, and these were used as indicators for adverse birth outcomes. Small size for gestational age was defined as gestational age < -2SD weight for GA. We found significant statistical associations between biomarkers for liver and kidney functions and adverse birth outcomes Apgar score and gestational age. No significant association was found between heavy metals Hg and lead and adverse birth outcomes.

Nine is the New Ten of Apgar Scores: An Observational Retrospective Cohort Study.

Apgar scores of 10 were once common but are now rare. We aggregated scores from US term infants from 1978 to 2021. We found that scores of 10 decreased by logarithmic decay independent of demographic changes. We hypothesize that this trend was driven by improved appreciation of transitional physiology.

Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis.

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.

Maternal and neonatal effects of epidural levobupivacaine combined with fentanyl or sufentanil for elective cesarean-section in brachycephalic breeds.

The aim of this study was to compare the safety and clinical efficacy of epidural levobupivacaine combined with fentanyl or sufentanil for bitches undergoing elective cesarean-section and the impact of these anesthetic protocols on neonatal viability. The anesthetic protocol consisted of intramuscular morphine (0.2 mg/kg), followed by an intravenous bolus of propofol, in a dose sufficient to allowed the puncture of the lumbosacral space. The dogs were randomly allocated to receive 0.5 % levobupivacaine plus fentanyl (2.5 µg/kg; LF: n = 9) or sufentanil (1 µg/kg; LS; n = 11). Maternal cardiorespiratory parameters were monitored at specific time points during surgery. Intraoperative propofol supplementation was based on the presence of head and/or thoracic limb movements. Neonatal reflex responses and the Apgar score (range 0-10 points) were assessed at 5 and 60 minutes after birth. Puppy mortality rate was recorded until 24 hours after birth. Data were analyzed using two-way ANOVA, Tukey's test, Wilcoxon signed rank test, and Fisher's exact test (P < 0.05). Intraoperatively, maternal cardiorespiratory variables and propofol requirements were similar between groups, with no detection of anesthetic complications. The puppy reflex responses did not differ between groups at any time point. The medians (range) of Apgar scores were lower (P = 0.016) in the LF [5 (1-9)] at 5 minutes in comparison with LS [6 (2-9)], while no intergroup differences were recorded at 60 minutes [LF = 8 (2-10); LS = 9 (6-10]. The total mortality rate was 4.1 %. In the LS group, no puppies died, while in the LF 8 % of the puppies died in the first 24 hours after birth (P = 0.11). Epidural levobupivacaine combined with fentanyl or sufentanil provided minimal maternal and neonatal adverse effects, but neither protocol enabled the performance of a C-section in 100 % of the French and English bulldogs, without propofol supplementation.

The effects of feeding sows at onset of farrowing supplemental energy (blend of carbohydrates and glycerol) on farrowing kinetics and piglet vitality.

Delivering piglets is one of the most energy-demanding activities sows undergo in their lifetime. Sows can have myometrial contractions from 2 to 12 h before the first piglet is expelled as well as a nest-building behavior. Thus, when the first piglet is delivered, the female has already used part of her energy supply. When the sow gets exhausted due to lack of energy, the farrowing process can be interrupted, causing damage to the viability and vitality of the piglets. In the present study, we evaluated the effects of feeding sows an energy supplement at the onset of farrowing on farrowing kinetics and piglet vitality. The energy supplement consisted of a blend of carbohydrates and glycerol which provides 439 kJ of metabolizable energy per kg of metabolic weight. A total of 180 sows were used. At the onset of farrowing, sows were assigned to one of the following treatments: sows that were not supplied energy at the onset of farrowing, serving as controls (CON, n = 85); sows fed the energy supplement at the onset of farrowing (ESP, n = 95). Farrowing kinetics, blood glucose concentration, and piglet vitality were recorded for each sow. Blood glucose concentration was assessed by puncturing the auricular vein and using a portable glucometer at four different time points: after the birth of the 1st piglet (T0), and at 20 (T20), 40 (T40), 80 (T80), and 180 (T180) min after the birth of the 1st piglet. The vitality of the 1st, 6th, 12th, 17th, and 20th piglet born was evaluated using the Apgar score. Piglet birth weight and average colostrum intake were measured. The farrowing duration was 20 min shorter (P < 0.05) for ESP sows in comparison with CON sows. Sows from ESP treatment had higher (P ≤ 0.05) blood glucose concentration at T20 and T40 compared to the CON sows. The inter-piglet birth interval was shortened (P < 0.05) by 14 min between the 1st and 2nd piglet for the ESP treatment. The 17th and 20th piglets born from ESP sows had higher (P < 0.05) Apgar score compared to piglets of the same birth order from CON sows. Colostrum intake was higher (P < 0.01) for piglets born from ESP sows. Litter growth performance did not differ (P > 0.05). In conclusion, feeding a blend of carbohydrates and glycerol as an energy supplement for farrowing sows improved farrowing kinetics and piglet vitality score.

Influence of maternal and perinatal complications on therapeutic hypothermia in newborns with low Apgar scores

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of therapeutic hypothermia on maternal and perinatal outcomes in newborns with Apgar score<7 at the 5th min. METHODS: A retrospective cohort study was carried out with 55 newborns who had an Apgar score<7 at the 5th min (35 without and 20 with therapeutic hypothermia) from low-risk pregnancies between 33 and 41 weeks gestation. The Apgar score was calculated through an objective assessment by a neonatologist in the delivery room. Therapeutic hypothermia was indicated by a neonatologist in the delivery room, according to the protocol established by the Brazilian Society of Pediatrics. The maternal and perinatal outcomes of both groups (without and with therapeutic hypothermia) were compared. RESULTS: A rate of Apgar score<7 at the 5th min was 1.02%. No statistical differences were observed between the two groups (without and with therapeutic hypothermia) regarding maternal/perinatal complications. The presence of maternal/perinatal complications did not increase the odds ratio of neonatal therapeutic hypothermia in newborns with Apgar score<7 at the 5th min. CONCLUSION: The rate of Apgar score<7 at the 5th min was low, and it was not associated with any maternal/perinatal complications. There was no significant difference in maternal/perinatal complications between newborns who received therapeutic hypothermia and those who did not.

La calificación Apgar

En 1949, la estudiante de Medicina, que no encontró el acceso para hacerse cirujano, se convertía en la primera mujer en ser profesora de tiempo completo en Columbia's College of Physicians and Surgeons, y tres años más tarde, en 1952, presentaba ante la reunión conjunta de la Sociedad Internacional de Investigación en Anestesia y el Colegio de Anestesiólogos -publicada al año siguiente una de las más logradas contribuciones clínicas, la forma de evaluar el estado de vigor del recién nacido a partir de 5 signos, que llevaría su nombre: la calificación Apgar

In 1949, the medical student, who did not find access to become a surgeon, became the first woman to be a full-time professor at Columbia's College of Physicians and Surgeons, and three years later, in 1952, she presented before the meeting joint effort of the International Society for Research in Anesthesia and the College of Anesthesiologists - published the following year[1] - one of the most successful clinical contributions, the way of evaluating the state of health of the newborn based on 5 signs, which would lead its name: the Apgar score

Hypoglycaemia management with a hypercaloric supplementation in neonatal puppies delivered by caesarean section.

There is a high perinatal mortality rate in dogs, estimated at 20%, and one of the leading causes of this rate is hypoglycaemia. Therefore, we aimed to evaluate the efficacy of a hypercaloric supplement containing vitamins and amino acids in newborn puppies presenting hypoglycaemia at birth. Ninety-nine pups were divided into four groups: normoglycaemic caesarean section (NORMOCS), hypoglycaemic caesarean section supplemented with the hypercaloric (SUPLCS), hypoglycaemic caesarean section supplemented with glucose (GLICCS) and eutocic delivery (EUT). We evaluated the following parameters glycaemia, Apgar score, neurological reflexes and rectal temperature of neonates at the following moments 5 min (M5), 30 min (M30) and 60 min (M60) after birth. Brachycephalic dogs were 73.3% (22/30) of caesarean sections (c-sections). The puppy's average glycaemia represented about 90% of the maternal glycaemia, while 15.1% (14/99) of the neonates had hypoglycaemia (<90 mg/dL) at M0 and 46.5% (44/99) at M60. Only four neonates had glycaemia below 40 mg/dL at M30 but without showing any clinical signs. The puppy's fasting while waiting for the intraoperative period and the dam's anaesthetic recovery was considered risk factors for hypoglycaemia. There was no difference in mean blood glucose levels or vitality parameters among puppies from the SUPLCS and GLICCS. In conclusion, the hypercaloric supplement can be used as a replacement for glucose in hypoglycaemic puppies and it can also bring nutritional benefits for the puppy. The prepartum glycaemia of the dam is an important parameter to be measured, and the appropriate management of it reduces the chances of the puppies being born with hypoglycaemia.

The Impact of the Place of Delivery, Type of Birth and Number of Antenatal Visits on the Apgar Score / O Impacto do Local de Parto, Tipo de Nascimento e Número de Visitas Pré-Natal no Índice de Apgar

The Apgar score is applied immediately after birth to clinically evaluate the newborn, at the first and fifth minutes of life. The Apgar score can help diagnose scenarios of neonatal anoxia or hypoxia. This is a retrospective, descriptive, and analytical study that used secondary data from DATASUS (Department of Informatics of the Unified Health System), from 1994 to 2018. The studied population includes all live births in Brazil during this period. The inclusion criteria were pregnant women over 15 years old, and the exclusion criteria were multiple pregnancies, pregnancies lasting less than 37 weeks, and newborns with congenital anomalies. These criteria were established to reduce potential confounding factors in the analysis that could lead to errors in interpretation of the results. The variables studied were place of delivery, type of delivery, and number of prenatal consultations. As results, having 7 or more prenatal consultations is a protective factor for alterations in the Apgar score, as well as cesarean delivery and hospital delivery. It was observed that pregnancy care, regarding the studied variables, influences the Apgar score. However, future studies in different populations are necessary to confirm these results.(AU)

O índice de Apgar é aplicado imediatamente após o nascimento, para avaliação clínica do recém-nascido, no primeiro e quinto minutos de vida. O índice de apgar é capaz de ajuda a diagnosticar cenários de anóxia ou hipóxia neonatal. Trata-se de um estudo retrospectivo, descritivo e analítico, que utilizou dados secundários do DATASUS (Departamento de Informática do Sistema Único de Saúde), de 1994 a 2018. A população estudada compreende todos os nascidos vivos no Brasil nesse período. Cujo critérios de inclusão foram: gestantes maiores de 15 anos e os critérios para a excluídas das gestantes, foram: gestações duplas, triplas e mais, gestações com menos de 37 semanas e recém-nascidos com anomalias congênitas, taís critérios foram estabelcidos afim de diminuir potenciais fatores de confusão a análise, que possam direcionar a discussão dos resultados ao erro de interpretação. As variáveis estudadas foram: local de parto, tipo de parto e número de consultas de pré-natal. Como resultados, possuir 7 ou mais consultas pré-natais, é um fator protetor para alterações no índice de Apgar, assim como parto cesáreo e parto hospitalar. Observou-se que os cuidados com a gravidez, no que diz respeito às variáveis estudadas, têm influência no escore de Apgar, entretanto futuros estudos em diferentes populações se torna necessário para confirmação desse resultado.(AU)

Descripción de analgesia de parto con lidocaína o bupivacaina y Apgar al nacer. Estudio observacional descriptivo retrospectivo

El trabajo de parto lleva con este la experiencia que causa uno de los dolores más intensos que se han descrito. En el Instituto de Seguridad Social de El Salvador (ISSS) se registran aproximadamente 600 a 700 partos vaginales por mes y de estos aproximadamente 10-20% solicitan analgesia para trabajo de parto, la cual el servicio de anestesia provee a través del abordaje epidural. Es conocido que se considera que el medicamento ideal para la analgesia de trabajo de parto es la bupivacaína o lidocaína 3, sin embargo, es de especial importancia describir el puntaje de APGAR de los recién nacidos de madres que recibieron cualquiera de estos dos fármacos por la vía ya mencionada. Objetivo: Determinar cómo influye el uso de lidocaína y bupivacaína como anestésico epidural sobre el puntaje APGAR posterior al nacimiento en mujeres embarazadas en fase activa del trabajo de parto con necesidad de analgesia epidural. Métodos: El presente es un estudio observacional descriptivo retrospectivo de fuentes primarias. El servicio de anestesiología del Hospital Materno Infantil Primero de Mayo cuenta con un registro sobre cuántos y a cuáles pacientes se les administra analgesia epidural por lo que el equipo investigador realizó una revisión de la técnica anestésica y se describe el Apgar al final del parto por vía vaginal en aquellas pacientes que recibieron analgesia epidural con lidocaína o bupivacaína. Se realizó el filtrado con la base de datos de Excel utilizando criterios de inclusión y exclusión, logrando incluir finalmente 81 pacientes en el análisis de los datos. Se encontró durante el escrutinio de estos que a 25 de estas se les realizó cesárea de emergencia y en 6 de estos mismos expedientes no se consignó de manera completa todos los datos necesarios para el análisis de ello, por lo que se utilizaron finalmente 51 expedientes clínicos para la realización de la presente investigación. Resultados: El APGAR promedio de los pacientes que recibieron analgesia de trabajo de parto con bupivacaína es de 8.75 y 8.9 al minuto y cinco minutos respectivamente y el promedio de APGAR alcanzado por los recién nacidos de pacientes que recibieron analgesia de trabajo de parto con lidocaína es de 9 puntos al minuto y cinco minutos. Conclusión: El promedio de APGAR en pacientes que recibieron bupivacaína es de 8.75 y el de lidocaína es de 9. (provisto por Infomedic International)

Labor brings with it the experience that causes one of the most intense pains ever described. At the Social Security Institute of El Salvador (ISSS) approximately 600 to 700 vaginal deliveries are registered per month and of these approximately 10-20% request labor analgesia, which the anesthesia service provides through the epidural approach. It is known that the ideal drug for labor analgesia is considered to be bupivacaine or lidocaine 3, however, it is of special importance to describe the APGAR score of newborns born to mothers who received either of these two drugs by the aforementioned route. Objective: To determine how the use of lidocaine and bupivacaine as epidural anesthetic influences the post-birth APGAR score in pregnant women in the active phase of labor requiring epidural analgesia. Methods: The present is a retrospective descriptive observational observational study from primary sources. The anesthesiology service of the Hospital Materno Infantil Primero de Mayo has a record of how many and to which patients epidural analgesia is administered, so the research team conducted a review of the anesthetic technique and described the Apgar at the end of vaginal delivery in those patients who received epidural analgesia with lidocaine or bupivacaine. Filtering was performed with the Excel database using inclusion and exclusion criteria, finally including 81 patients in the data analysis. It was found during the scrutiny of these that 25 of them had undergone emergency cesarean section and in 6 of these same records not all the data necessary for the analysis were completely recorded, so that 51 clinical records were finally used for the present investigation. Results: The average APGAR of the patients who received labor analgesia with bupivacaine was 8.75 and 8.9 at one minute and five minutes respectively, and the average APGAR achieved by the newborns of patients who received labor analgesia with lidocaine was 9 points at one minute and five minutes. Conclusion: The average APGAR in patients who received bupivacaine is 8.75 and that of lidocaine is 9. (provided by Infomedic International)

Proporção e fatores associados a Apgar menor que 7 no 5º minuto de vida: de 1999 a 2019, o que mudou? / Proportion and factors associated with Apgar less than 7 in the 5th minute of life: from 1999 to 2019, what has changed?

Resumo Apesar da variação entre observadores na avaliação do escore de Apgar, ele permanece um indicador útil das condições gerais do recém-nascido. O presente trabalho é um estudo de corte transversal baseado na população de nascidos vivos no Brasil no ano de 1999 e no biênio 2018-2019. Foram avaliadas todas as declarações de nascidos vivos (DNV) obtidas a partir do banco de dados do Sistema de Informações sobre Nascidos Vivos. As frequências foram comparadas entre os grupos por meio do teste qui-quadrado de Pearson e foi realizada análise de regressão logística multivariada. Adotou-se nível de significância estatística de 0,05. Foram analisadas 9.050.521 DNVs em nossa pesquisa. Constatamos que 2,1% dos recém-nascidos tiveram Apgar de 5º minuto < 7 em 1999, em comparação com 0,9% em 2018-2019. A análise multivariada indicou que gemelidade e gravidez na adolescência deixaram de ser fatores de risco para Apgar de 5º minuto < 7. Entre os fatores de risco, nota-se aumento da prematuridade, baixo peso ao nascer e anomalias congênitas. Observou-se melhoria de marcadores maternos, em especial o aumento do número de consultas pré-natais e escolaridade. Tais achados mostram a importância de acesso e seguimento pré-natal adequado e investimento em melhores condições socioeconômicas como estratégia eficaz para redução de morbimortalidade neonatal.

Abstract Although variation between observers in the assessment of the Apgar score, it remains a useful indicator of the general conditions of the newborn. This is a cross-sectional study based on population of live births in Brazil in 1999 and biennium 2018-2019. All declarations of live births (DNV) obtained from the Live Births System database were accessed. Frequencies were compared between groups using Pearson's chi-square test and multivariate logistic regression analysis was performed. A statistical significance level of 0.05 was considered. We included 9.050.521 DNVs in our research. We found that 2,1% of newborns had 5th minute Apgar < 7 in 1999 compared with 0,9% in 2018-2019. Multivariate analysis shows that twins and teenage pregnancy are no longer risk factors. Among risk factors, we observed an increase in prematurity, low birth weight and congenital anomalies. An improvement in maternal markers was observed, especially increase in the number of prenatal consultations and schooling. Such findings demonstrate the importance access and adequate prenatal care and improved socioeconomic conditions as effective strategy to reduce neonatal morbidity and mortality.

Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case-control study.

PURPOSE: To search for maternal, labor-related and fetal variables associated with low Apgar in the fifth minute in term pregnancy. METHODS: A retrospective case-control study with term births was conducted in a public teaching hospital from 2013 to 2020. Cases were term births with Apgar score less than 7 in the fifth minute, and controls, the next one or two births following a case, with Apgar of 7 or more. Non-cephalic presentations, multiples and malformations were excluded. We accessed 100 cases and 190 controls. We considered significant values of p < 0.05. RESULTS: Were accessed 27 variables which could be risk factors, from which 12 were associated with the outcome. We found a protective effect of prelabor cesarean for the outcome, odds ratio (OR) 0.38, p = 0.013. Consequently, we conducted two sets of analyses: in the whole group and in the group of laboring women. The values of OR were in general greater in the group of laboring women, compared with the whole group. We conducted multivariate analysis within the group of women in labor. The variables which fitted best in the model were nulliparity, male sex of the fetus, less than six prenatal visits and abnormal cardiotocography; all remained significant. An association of rupture of membranes more than 360 min with the outcome, even after controlling fpr duration of labor, was found; adjusted OR 2.45, p = 0.023. CONCLUSION: Twelve variables were associated with the outcome. Prelabor cesarean had a protective effect. The time of ruptured membranes was associated with low Apgar.

Comparison of Apgar score, serum lactate, and blood gas analysis in neonates born by elective cesarean section or cesarean section after dystocia / Comparação do escore Apgar, lactato sérico e hemogasometria em neonatos nascidos por cesariana eletiva e cesariana após distocia

ABSTRACT: In some situations, the neonatal mortality rate in dogs can be high, and perinatal and postnatal veterinary care is essential to improve survival. This study to compared the Apgar score, serum lactate levels, and blood gas analysis results in 30 neonates born by elective cesarean section (GCE, n = 18) or cesarean section due to dystocia (GD, n = 12). Neonates were assessed at five time points: T0, at birth; T1, 3 h after birth; T2, 6 h after birth; T3, 12 h after birth; and T4, 24 h after birth. At T0, in the GCE group, 55.6% of the animals presented with adequate vitality, while 38.8% showed moderate changes in the Apgar score. In the GD group, 83.3% of the neonates had severe loss of vitality. At T1, none of the GCE neonates and 8.3% of the GD neonates presented with vitality deficits. Hyperlactatemia was observed in 83.3% of the GD neonates, and mixed acidosis (metabolic and respiratory) was observed at T0 in most neonates in both groups (GCE, 55.6%; GD, 72.7%). Compared to GCE neonates, the acid-base disorders were more severe and their recovery slower in GD neonates. At T0, GD neonates had higher hyperlactatemia and a lower Apgar score (worse vitality) than those of GCE neonates.

RESUMO: A taxa de mortalidade neonatal em cães pode ser elevada em algumas situações e a assistência veterinária peri e pós-natal mostra-se essencial para melhorar a sobrevivência dos filhotes nesse período. O objetivo deste estudo foi comparar o escore Apgar, lactato sérico e hemogasometria em neonatos nascidos por cesariana eletiva (GCE, n=18) e por cesariana após distocia (GD, n=12). Os neonatos foram avaliados em cinco momentos: (T0) ao nascimento; (T1) três horas; (T2) seis horas; (T3) 12 horas; e (T4) 24 horas. Ao nascimento, no GCE, 55,6% dos animais apresentaram boa vitalidade, de acordo com escore Apgar, e 38,8% demonstraram moderada vitalidade. No GD, 83,3% dos neonatos apresentaram baixa vitalidade. Ao T1 (três horas após o nascimento), nenhum (0%) dos neonatos do GCE e 8,3% dos neonatos do GD evidenciavam perda de vitalidade. Observou-se hiperlactatemia em 83,3% nos neonatos do GD e acidose mista (metabólica e respiratória) ao nascimento na maioria dos neonatos de ambos os grupos (55,6% no GCE e 72,7% no GD). Conclui-se que o principal distúrbio ácido-base observado ao nascimento foi acidose mista (metabólica e respiratória) em ambos os grupos. Os distúrbios acido-base nos neonatos do GD foram mais graves e sua recuperação mais lenta quando comparados com neonatos do GCE. Ao nascimento, neonatos no GD apresentaram maior hiperlactatemia e menor escore Apgar (pior vitalidade) em relação aos nascidos no GCE.

Comparison of Apgar score, serum lactate, and blood gas analysis in neonates born by elective cesarean section or cesarean section after dystocia / Comparação do escore Apgar, lactato sérico e hemogasometria em neonatos nascidos por cesariana eletiva e cesariana após distocia

In some situations, the neonatal mortality rate in dogs can be high, and perinatal and postnatal veterinary care is essential to improve survival. This study to compared the Apgar score, serum lactate levels, and blood gas analysis results in 30 neonates born by elective cesarean section (GCE, n = 18) or cesarean section due to dystocia (GD, n = 12). Neonates were assessed at five time points: T0, at birth; T1, 3 h after birth; T2, 6 h after birth; T3, 12 h after birth; and T4, 24 h after birth. At T0, in the GCE group, 55.6% of the animals presented with adequate vitality, while 38.8% showed moderate changes in the Apgar score. In the GD group, 83.3% of the neonates had severe loss of vitality. At T1, none of the GCE neonates and 8.3% of the GD neonates presented with vitality deficits. Hyperlactatemia was observed in 83.3% of the GD neonates, and mixed acidosis (metabolic and respiratory) was observed at T0 in most neonates in both groups (GCE, 55.6%; GD, 72.7%). Compared to GCE neonates, the acid-base disorders were more severe and their recovery slower in GD neonates. At T0, GD neonates had higher hyperlactatemia and a lower Apgar score (worse vitality) than those of GCE neonates.

A taxa de mortalidade neonatal em cães pode ser elevada em algumas situações e a assistência veterinária peri e pós-natal mostra-se essencial para melhorar a sobrevivência dos filhotes nesse período. O objetivo deste estudo foi comparar o escore Apgar, lactato sérico e hemogasometria em neonatos nascidos por cesariana eletiva (GCE, n=18) e por cesariana após distocia (GD, n=12). Os neonatos foram avaliados em cinco momentos: (T0) ao nascimento; (T1) três horas; (T2) seis horas; (T3) 12 horas; e (T4) 24 horas. Ao nascimento, no GCE, 55,6% dos animais apresentaram boa vitalidade, de acordo com escore Apgar, e 38,8% demonstraram moderada vitalidade. No GD, 83,3% dos neonatos apresentaram baixa vitalidade. Ao T1 (três horas após o nascimento), nenhum (0%) dos neonatos do GCE e 8,3% dos neonatos do GD evidenciavam perda de vitalidade. Observou-se hiperlactatemia em 83,3% nos neonatos do GD e acidose mista (metabólica e respiratória) ao nascimento na maioria dos neonatos de ambos os grupos (55,6% no GCE e 72,7% no GD). Conclui-se que o principal distúrbio ácido-base observado ao nascimento foi acidose mista (metabólica e respiratória) em ambos os grupos. Os distúrbios acido-base nos neonatos do GD foram mais graves e sua recuperação mais lenta quando comparados com neonatos do GCE. Ao nascimento, neonatos no GD apresentaram maior hiperlactatemia e menor escore Apgar (pior vitalidade) em relação aos nascidos no GCE.

Fatores associados ao baixo apgar em recém-nascidos angolanos / Factors associated with low apgar in angolan newborn / Factores asociados con apgar bajo en recién nacidos angolanos

Objetivo:avaliar os fatores associados ao baixo Apgar em recém-nascidos de Angola. Método:estudo analíticoe transversal, quali-quantitativo, em umHospital Geral de Luanda, Angola, entre março e maio de 2021. Realizou-se entrevistas em sala de observação e consulta aos prontuários das parturientes. Os dados foram analisados pelo teste qui-quadrado (X2) e regressão logística. Resultados:prevaleceu parturientes entre 19-35 anos (70,0%), 7º-9º ano (57,5%), multíparas (75%), multigestas (75,0%), sem histórico de aborto (72,5%), idade gestacional de 40 semanas (60,0%), usuárias de bebidas alcoólicas (77,5%), baixa frequência de consultas pré-natais (52,5%), com parto natural (82,5%) e recém-nascidos com peso normal (52,5%). Mulheres de região periurbana [OR:6,85 (95% CI:0.65-71,2), p=0,108] e rural [OR:4,47 (95% CI:0.47-48,4), p=0,184] apresentaram maior chance de terem recém-nascidos com baixo Apgar, assim como as usuárias de álcool [OR:3,28 (95% CI:0,58-18,3), p=0,176] e recém-nascidos que nasceram com peso normal [OR:1,75 (95% CI:0,49­6,22), p=0,387]. Não houve associação estatística entre os dados sociodemográficos e maternos. Conclusão:a faixa etária, local de residência, consumo de álcool materno e peso do recém-nascido podem implicar em baixo Apgar.

Objective: to evaluate the factors associated with low Apgar in newborns in Angola. Method:analytical and cross-sectional, quali-quantitative study, in a General Hospital in Luanda, Angola, between March and May 2021. Interviews were carried out in an observation room and consultation of the parturients' medical records. Data were analyzed using the chi-square test (X2) and logistic regression.Results: pregnant women aged 19-35 years (70.0%), 7th-9th year(57.5%), multiparous (75%), multiparous (75.0%), without a history of abortion (72.5%), prevailed. gestational age of 40 weeks (60.0%), users of alcoholic beverages (77.5%), low frequency of prenatal consultations (52.5%), with natural childbirth (82.5%) and newborns with normal weight (52.5%). Women from peri-urban regions [OR:6.85 (95% CI:0.65-71.2), p=0.108] and rural [OR:4.47 (95% CI:0.47-48.4), p=0.184] were more likely to have low Apgar newborns, as well as alcohol users [OR:3.28 (95% CI:0.58-18.3), p=0.176] and newborns who were born with normal [OR:1.75 (95% CI:0.49­6.22), p=0.387]. There was no statistical association between sociodemographic and maternal data.Conclusion: age group, place of residence, maternal alcohol consumption and newborn weight may imply low Apgar.

Objetivo: evaluar los factores asociados al Apgar bajo en recién nacidos en Angola.Método: estudio analítico y transversal, cuali-cuantitativo, en un Hospital General de Luanda, Angola, entre marzo y mayo de 2021. Se realizaron entrevistas en sala de observación y consulta de las historias clínicas de las parturientas. Los datos se analizaron mediante la prueba de chi-cuadrado (X2) y regresión logística. Resultados: gestantes de 19 a 35 años (70,0%), de 7° a 9° año (57,5%), multíparas (75%), multíparas (75,0%), sin antecedente de aborto (72,5%), predominó la edad gestacional de 40 semanas (60,0%), usuarias de bebidas alcohólicas (77,5%), baja frecuencia de consultas prenatales (52,5%), con parto natural (82,5%) y recién nacidos con normopeso (52,5%). Las mujeres de regiones periurbanas [OR:6,85 (IC 95%:0,65-71,2), p=0,108] y rurales [OR:4,47 (IC 95%:0,47-48,4), p=0,184] tenían más probabilidades de tener bajo Recién nacidos Apgar, así como consumidores de alcohol [OR:3,28 (IC 95%:0,58-18,3), p=0,176] y recién nacidos que nacieron con normalidad [OR:1,75 (IC 95%:0,49-6,22), p=0,387]. No hubo asociación estadística entre datos sociodemográficos y maternos. Conclusión: el grupo de edad, el lugar de residencia, el consumo materno de alcohol y el peso del recién nacido pueden implicar un Apgar bajo.

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.

Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study.

Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.

Characterizing Infant Mortality Using Data Mining - A Case Study in Two Brazilian States - Santa Catarina and Amapá.

Infant mortality is characterized by the death of young children under the age of one, and it is an issue affecting millions of children in the world. The objective of this article is to employ concepts of knowledge discovery in databases, specifically of machine learning in the data mining phase, to characterize infant mortality in two states of Brazil: Santa Catarina, with the lowest infant mortality rate of the country's states, and Amapá, with the highest. The classifiers C4.5, JRip, Random Forest, SVM, and Multilayer Perceptron were used, and a brief comparison of the results obtained by the classifiers in both states is made. In addition, the dataset preprocessing is detailed, which includes attribute selection and class balancing. The results show that the features APGAR5, WEIGHT, and CONGENITAL ANOMALY stood out the most from the rules generated by the tree-based classifiers.

Apgar quirúrgico como criterio de activación de código 77 en el Hospital Ángeles Pedregal / Surgical Apgar score as a criteria for activation of code 77 at Angeles Pedregal Hospital

Resumen: Introducción: El Apgar quirúrgico (AQ) es un sistema de 10 puntos que valora tres variables intraoperatorias: frecuencia cardíaca más baja, presión arterial media más baja y sangrado. El AQ es un indicador de la mortalidad y morbilidad en el postoperatorio inmediato. Objetivo: Describir la incidencia del puntaje AQ en pacientes postoperados y con activación del código 77 en el Hospital Ángeles Pedregal. Material y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal que incluyó pacientes con indicación de activación del código 77 en su postoperatorio inmediato y traslado a Unidad de Cuidados Intensivos, durante el período de enero a diciembre de 2015 en el Hospital Ángeles Pedregal. Resultados: Se contó con 58 pacientes de los cuales 68% obtuvieron un Apgar quirúrgico ≥ 7 puntos (estables) y 32% un Apgar quirúrgico 6 (inestables). La incidencia del Apgar quirúrgico 6 para el período de estudio fue de 12 casos por cada 100 personas intervenidas con una sensibilidad del 68%. Conclusiones: El AQ puede considerarse un criterio confiable para la activación del código 77 en aquellos pacientes con puntaje AQ ≤ 6 durante el postoperatorio inmediato, permitiendo un manejo oportuno de las complicaciones postquirúrgicas y la disminución de riesgo de morbimortalidad.

Abstract: Introduction: The surgical Apgar score (SAS) is a 10-point system that assesses three intraoperative variables: lower heart rate, lower mean arterial pressure, and bleeding. SAS is an indicator of mortality and morbidity in the immediate postoperative period. Objective: To describe the incidence of the SAS in postoperative patients with activation of code 77. Material and methods: Observational, transversal, retrospective and descriptive study, included patients with indication of activation of code 77 during their immediate postoperative time, and transferred to the Intensive Care Unit, during the period from January to December 2015. Results: 68% of the sample obtained a SAS greater than or equal to 7 points (stable patient), and 32% a SAS less than or equal to 6 (unstable). The incidence of SAS less than or equal to 6 points for the period of the study was about 12 cases per 100 persons intervened with a sensibility of 68%. Conclusions: SAS should be taken as another criteria for the activation of code 77 in those patients with a result lower than 6 points; during the immediate postoperative period, allowing a timely management of postoperative complications and a reduction on the risk of morbidity and mortality.

Factores de riesgo maternos y perinatales asociados a Apgar bajo en recién nacidos de término. Estudio retrospectivo de casos y controles

Objetivo: Cada año nacen, aproximadamente, 130 millones de niños a nivel mundial, de los cuales 3.3 millones nacen muertos y más de 4 millones fallecen en los primeros 28 días de vida. Según la Organización Mundial de la Salud, la mortalidad perinatal representa más de la mitad de la mortalidad infantil en el mundo. La medida usada de manera más consistente para determinar la salud neonatal a los pocos minutos de vida es la puntuación de Apgar, la cual proporciona al personal de salud una comprensión sobre el estado del recién nacido. Métodos: Se realizó un estudio retrospectivo de casos y controles, con una muestra de 303 registros de nacimientos de término (mayor o igual a 37 semanas), obtenidos de la base de datos de Historias Clínicas Perinatales de los años 2017-2018. La población de estudio fue distribuida en una proporción 1:2 (101 casos vs. 202 controles). Los casos fueron aquellos neonatos con puntajes de Apgar al quinto minuto menor a 7, mientras que los controles tuvieron en la misma medida puntajes mayores o iguales a 7. Se realizó un análisis estadístico de los datos, para determinar factores de riesgo de Apgar bajo. Resultados: Las variables que se presentaron como factores de riesgo para puntaje Apgar bajo al nacer fueron la presencia de diabetes [(5.9% vs. 0.49%, p=0.006); OR: 12.69; 95% IC: 1.51-106.93)] y el parto por cesárea [(52.6% vs. 26.28%, p=0.00007); OR: 3.11 (95% IC: 1.86-5.20)]. Conclusión: Después de analizar diversos factores de riesgo descritos en la literatura, la presencia de diabetes es un importante factor de riesgo para puntajes de Apgar bajo a los 7 minutos, por lo que especial atención se les debe prestar a los pacientes con esta patología durante la atención periparto. Aun cuando la interrupción vía cesárea también se reportó como un factor de riesgo, el procedimiento se debe analizar en el contexto de la causal de la misma, por lo que se requieren más estudios para determinar la relación entre la indicación del procedimiento y el puntaje Apgar bajo a los 7 minutos. (provisto por Infomedic Intl)

Objective: Every year, approximately 130 million infants are born worldwide, of which 3.3 million are stillborn and more than 4 million die in the first 28 days of life. According to the World Health Organization, perinatal mortality accounts for more than half of infant mortality worldwide. The most consistently used measure of neonatal health within minutes of birth is the Apgar score, which provides health care providers with an understanding of the newborn's condition. Methods: A retrospective case-control study was performed, with a sample of 303 term birth records (greater than or equal to 37 weeks), obtained from the Perinatal Medical Records database for the years 2017-2018. The study population was distributed in a 1:2 ratio (101 cases vs. 202 controls). Cases were those neonates with Apgar scores at the fifth minute less than 7, while controls had in the same measure scores greater than or equal to 7. Statistical analysis of the data was performed, to determine risk factors for low Apgar. Results: The variables that were presented as risk factors for low Apgar score at birth were the presence of diabetes [(5.9% vs. 0.49%, p=0.006); OR: 12.69; 95% IC: 1.51-106.93)] and cesarean delivery [(52.6% vs. 26.28%, p=0.00007); OR: 3.11 (95% IC: 1.86-5.20)]. Conclusion: After analyzing several risk factors described in the literature, the presence of diabetes is an important risk factor for low Apgar scores at 7 minutes, so special attention should be paid to patients with this pathology during peripartum care. Although termination via cesarean section was also reported as a risk factor, the procedure should be analyzed in the context of its causality, and further studies are needed to determine the relationship between the indication for the procedure and low Apgar score at 7 minutes. (provided by Infomedic Intl)