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Outcomes related to 10-min Apgar scores of zero in Japan
  1. Jun Shibasaki1,
  2. Takeo Mukai2,
  3. Kennosuke Tsuda3,
  4. Akihito Takeuchi4,
  5. Tomoaki Ioroi5,
  6. Hiroyuki Sano6,
  7. Nanae Yutaka6,
  8. Akihito Takahashi7,
  9. Hisanori Sobajima8,
  10. Masanori Tamura8,
  11. Shigeharu Hosono9,
  12. Makoto Nabetani6,
  13. Osuke Iwata3
  14. The Baby Cooling Registry of Japan Collaboration Team
  1. 1 Department of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan
  2. 2 Center for Advanced Medical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
  3. 3 Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
  4. 4 Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
  5. 5 Himeji Red Cross Hospital, Hyogo, Japan
  6. 6 Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
  7. 7 Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
  8. 8 Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
  9. 9 Department of Perinatal and Neonatal Medicine, Jichi Ika University Saitama Medical Center, Saitama, Japan
  1. Correspondence to Dr Osuke Iwata, Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; o.iwata{at}med.nagoya-cu.ac.jp

Abstract

Objective Apgar scores of zero at 10 min strongly predict mortality and morbidity in infants. However, recent data reported improved outcomes among infants with Apgar scores of zero at 10 min. We aimed to review the mortality rate and neurodevelopmental outcomes of infants with Apgar scores of zero at 10 min in Japan.

Design Observational study.

Patients Twenty-eight of 768 infants registered in the Baby Cooling Registry of Japan between 2012 and 2016, at >34 weeks’ gestation, with Apgar scores of zero at 10 min who were treated with therapeutic hypothermia.

Interventions We investigated the time of first heartbeat detection in infants with favourable outcomes and who had neurodevelopmental impairments or died.

Main outcome measures Clinical characteristics, mortality rate and neurodevelopmental outcomes at 18–22 months of age were evaluated.

Results Nine (32%) of the 28 infants died before 18 months of age; 16 (57%) survived, but with severe disabilities and 3 (11%) survived without moderate-to-severe disabilities. At 20 min after birth, 14 of 27 infants (52%) did not have a first heartbeat, 13 of them died or had severe disabilities and one infant, who had the first heartbeat at 20 min, survived without disability.

Conclusion Our study adds to the recent evidence that neurodevelopmental outcomes among infants with Apgar scores of zero at 10 min may not be uniformly poor. However, in our study, all infants with their first heartbeat after 20 min of age died or had severe disabilities.

  • apgar score
  • hypoxic-ischemic encephalopathy
  • newborn
  • developmental outcome
  • resuscitation
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Footnotes

  • Contributors Guarantors of the integrity of the entire study: JS, TM KT, AT and OI; study concept/study design or data acquisition or data analysis/interpretation: all authors; manuscript drafting or manuscript revision for important intellectual content: all authors; manuscript final version approval: all authors; literature research: JS, KT and OI and manuscript editing: all authors.

  • Funding This study was funded by special research in perinatal medicine (grant no: H27-001).

  • Competing interests None declared.

  • Ethics approval The registry protocols were approved by the Ethics Committees of Kurume University School of Medicine and Saitama Medical University, Japan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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