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      Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia

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          Abstract

          Background

          Apgar score is currently an accepted method for newborn infant assessment immediately after delivery. Low fifth minute Apgar score was strongly associated with the risk of neonatal and infant death. Even though much has been done, still, the levels of neonatal mortality in sub-Saharan African countries including Ethiopia were significant. Therefore, this study is aimed at identifying the risk factors so as providing strategies for decreasing the morbidity and mortality of newborns and identifying determinants of low fifth minute Apgar score among newborns delivered in Jimma University Medical Center, Southwest Ethiopia, 2018.

          Method

          Institution-based cross-sectional study was conducted involving 366 neonates delivered at Jimma University Medical Center. Data was collected by using interview questionnaire. Apgar score was assessed by standard tool at the 1st, 5th, and 10th minutes after birth and only 5 th minute Apgar score was used as outcome variable. Consecutive sampling technique was used to select the participants. The collected data were analyzed using SPSS version 20.0. Chi-square test was done at bivariate level and P value was used to select candidate variables for multivariate analysis. Finally, a 95% confidence interval was used to assess significance.

          Results

          A response rate of this study was 95%. The proportion of low 5th minute Apgar score in this study was 11.5%. Prolonged duration of labor (AOR = 15.18, 95% CI: 5.51-40.27), maternal history of khat use (AOR = 3.21, 95% CI: 1.26-8.85), and low birth weight (AOR = 1.65, 95% CI: 1.02-3.11) were predictors of low fifth minute Apgar score.

          Conclusion

          About one tenth of newborns were having low 5th minute Apgar score. The likelihood of low 5 th minute Apgar score was found to increase with prolonged duration of labor, history of mother's khat use, and low birth weight.

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          Most cited references17

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          Association of Apgar score at five minutes with long-term neurologic disability and cognitive function in a prevalence study of Danish conscripts

          Background Apgar score is used for rapid assessment of newborns. Low five-minute Apgar score has been associated with increased risk of severe neurologic outcome, but data on milder outcomes, particularly in the long term, are limited. We aimed to examine the association of five-minute Apgar score with prevalence of neurologic disability and with cognitive function in early adulthood. Methods We conducted a prevalence study among draft-liable men born in Denmark in 1978–1983 and presenting for the mandatory army evaluation in a northern Danish conscription district. We linked records of this evaluation, which includes medical exam and intelligence testing, with the conscripts' records in the Medical Birth Registry, containing perinatal data. We examined prevalence of neurologic disability and of low cognitive function according to five-minute Apgar score. Results Less than 1% (136/19,559) of the conscripts had 5-minute Apgar scores <7. Prevalence of neurologic disability was 2.2% (435/19,559) overall; among conscripts with Apgar scores <7, 7–9, and 10 (reference), it was 8.8%, 2.5%, and 2.2% respectively. The corresponding prevalences of low cognitive function (intelligence test score in the bottom quartile) were 34.9%, 27.2%, and 25.0%. The outcomes were more prevalent if Apgar score <7 was accompanied by certain fetal or obstetric adversities. After accounting for perinatal characteristics, 5-mintue Apgar score <7 was associated with prevalence ratios of 4.02 (95% confidence interval: 2.24; 7.24) for neurologic disability and 1.33 (0.94; 1.88) for low cognitive function. Conclusion A five-minute Apgar score <7 has a consistent association with prevalence of neurologic disability and with low cognitive function in early adulthood.
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            Prolonged second stage of labor is associated with low Apgar score.

            There is no consensus on the effects of a prolonged second stage of labor on neonatal outcomes. In this large Swedish population-based cohort study, our objective was to investigate prolonged second stage and risk of low Apgar score at 5 min. All nulliparous women (n = 32,796) delivering a live born singleton infant in cephalic presentation at ≥37 completed weeks after spontaneous onset of labor between 2008 and 2012 in the counties of Stockholm and Gotland were included. Data were obtained from computerized records. Exposure was time from fully retracted cervix until delivery. Logistic regression analyses were used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Adjustments were made for maternal age, height, BMI, smoking, sex, gestational age, sex-specific birth weight for gestational age and head circumference. Epidural analgesia was included in a second model. The primary outcome measure was Apgar score at 5 min <7 and <4. We found that the overall rates of 5 min Apgar score <7 and <4 were 7.0 and 1.3 per 1000 births, respectively. Compared to women with <1 h from retracted cervix to birth, adjusted ORs of Apgar score <7 at 5 min generally increased with length of second stage of labor: 1 to <2 h: OR 1.78 (95% CI 1.19-2.66); 2 to <3 h: OR 1.66 (1.05-2.62); 3 to <4 h: OR 2.08 (1.29-3.35); and ≥4 h: OR 2.71 (1.67-4.40). We conclude that prolonged second stage of labor is associated with an increased risk of low 5 min Apgar score.
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              Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia

              Back ground New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality. Objective To assess proportion and factors associated with low 5 th minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. Methods A cross-sectional study was conducted on singleton 261 live births from March – May, 2013. Data was collected from mother/newborn index using a structured and pre-tested questionnaire. It was then cleaned, coded and entered using EPI INFO version 3.4.3, then analyzed with IBM SPSS statistics versions 20.0. Logistic regression was used to identify significant variables with low 5 th minute Apgar score. Result The proportion of low 5 th minute Apgar score in this study was 13.8%. Factors that were significantly associated with low 5 th minute Apgar score were: non-vertex fetal presentation, prolonged labor, presence of meconium stained liquor, induced/augmented labor and low birth weight. Conclusion Mainly obstetric factors contribute to low Apgar score. Improving labor management through implementing regular use of partograph, 1:1 midwife-client ratio and advanced electronic fetal monitoring technology is recommended.
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                Author and article information

                Contributors
                Journal
                Int J Pediatr
                Int J Pediatr
                IJPEDI
                International Journal of Pediatrics
                Hindawi
                1687-9740
                1687-9759
                2020
                4 March 2020
                : 2020
                : 9896127
                Affiliations
                1Department of Biomedical Sciences (Anatomy), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
                2Department of Biomedical Sciences (Anatomy), Collage of Health and Medical Sciences, Debre Berhan University, Debre Berhan, Ethiopia
                3Department of Pharmacy (Clinical Pharmacy), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
                4Department of Biomedical Sciences (Physiology), Institute of Health Sciences, Jimma University, Jimma, Ethiopia
                Author notes

                Academic Editor: Alessandro Mussa

                Author information
                https://orcid.org/0000-0001-8919-1429
                https://orcid.org/0000-0001-5820-0396
                https://orcid.org/0000-0002-4512-2111
                https://orcid.org/0000-0002-9834-0809
                Article
                10.1155/2020/9896127
                7077037
                32206062
                57a8df48-3d3c-4130-bb6e-089f1f6a94a0
                Copyright © 2020 Bekalu Getachew et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 November 2019
                : 22 February 2020
                Categories
                Research Article

                Pediatrics
                Pediatrics

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