Newborn assessment and long-term adverse outcome: A systematic review,☆☆

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Abstract

The medical literature was searched for publications between 1966 and September 1997 for data on the association of Apgar score, umbilical blood pH, or Sarnat grading of encephalopathy with long-term adverse outcome. Odds ratios for these associations were combined to calculate common odds ratios with 95% confidence intervals. Our search identified abstracts of 1312 studies and 81 articles with sufficient numeric data to formulate contingency tables. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by comparing umbilical artery pH <7 with pH ≥7 (common odds ratio 43; 95% confidence interval 15-124) and by comparing Sarnat grade III with grade II (common odds ratio 24; 95% confidence interval 13-45). In the prediction of cerebral palsy, the strongest associations were found for Sarnat grade III versus grade II (common odds ratio 20; 95% confidence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (common odds ratio 15; 95% confidence interval 5-50). (Am J Obstet Gynecol 1999;180:1024-9.)

Section snippets

Methods

We searched the medical literature from 1966 to September 1997 for studies examining the association between newborn assessment scores and long-term adverse outcome. DIMDI (Deutsches Institut für Medizinische Dokumentation und Information) was used as a host to search 20 common medical databases, including MEDLINE, on the association between Apgar score or cord blood pH and long-term adverse outcome. We searched for the following key words, alone or in combination: Apgar score, umbilical cord

Results

Our literature search resulted in 1312 abstracts. We read 281 articles, 213 derived from the search and 68 found among the references of these papers. Of these 281 studies, 81 provided sufficient numeric data to construct contingency tables. Thirty-nine of these 81 studies were subsequently excluded because they reported on patients already included in the meta-analysis, or because they used cutoff levels or outcome definitions that differed from those in most other studies. In the remaining 42

Comment

Although numerous studies address newborn assessment and serious adverse outcome, only a limited number provide sufficient data to construct contingency tables. Eight studies provided data on large cohorts of children4, 5, 6, 7, 8, 9, 10, 11; the others provided data on more restricted groups.2, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 A reasonable criticism of studies such as ours is that data are pooled

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