General Obstetrics and Gynecology Obstetrics
Outcome after successful resuscitation of babies born with Apgar scores of 0 at both 1 and 5 minutes

https://doi.org/10.1067/mob.2000.104951Get rights and content

Abstract

Objective: Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes. Study Design: Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, where available, of babies who met the above criteria occurring between January 1986 and February 1999 were reviewed. Results: Thirty-three of 81,603 infants (0.4/1000 births) met our study criteria. Twenty-two (67%) babies died during hospitalization. Mortality decreased significantly from 100% for babies with a birth weight of <750 g to 38% for those weighing ≥2500 g at birth (P = .03). All 6 babies delivered before 26 weeks’ gestation died. The incidence of 10-minute Apgar scores >0 was significantly higher among survivors than among those who subsequently died (82% vs 33%, P < .05). Nine survivors had hypoxic-ischemic encephalopathy diagnosed before discharge. Of the 7 infants with available follow-up, 4 had significant persisting morbidity. Two infants had normal neurologic examinations at follow-up. Conclusion: Survival in babies born with 1- and 5-minute Apgar scores of 0 is predicted by birth weight, gestational age, and 10-minute Apgar score. Long-term sequelae are common but not ensured. (Am J Obstet Gynecol 2000;182:1210-4.)

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Material and methods

Patients were identified from the perinatal database of the University of Tennessee, Memphis, for deliveries between January 1986 and February 1999. Infants having an Apgar score of 0 at both 1 and 5 minutes but who were subsequently successfully resuscitated and transferred to the neonatal intensive care unit were included in this analysis. Chart review of the paired mother and baby records meeting the inclusion criteria was conducted. For each woman, categoric data were collected concerning

Results

During the study period, 81,603 babies (>22 weeks’ gestation, weight >500 g, or both) were delivered at Crump Women’s Hospital, the University of Tennessee, Memphis. Of these, 103 apparently stillborn babies (1-minute Apgar score of 0) without malformations were successfully resuscitated (1.26/1000). Thirty-three infants were identified as having an Apgar score of 0 at both 1 and 5 minutes. Maternal characteristics are shown in Table I.

. Mothers’ characteristics (N = 33)

Age (y, mean ± SD)24.4 ±

Comment

This study was undertaken to evaluate infant outcome after successful cardiopulmonary resuscitation of infants who had Apgar scores of 0 at both 1 and 5 minutes because of the paucity of available data in this regard.

The existing literature has focused on apparent stillborn babies (Apgar score of 0 at 1 minute) with a small number of newborns meeting our inclusion criteria. There are three published trials in which outcomes after successful resuscitation of infants with Apgar scores of 0 at

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