Artikel:
Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden
BMJ 2018
Vi tænker det nok alle når vi står på fødegangen eller på sectiostuen med et dårligt nyfødt barn; ”Med den APGAR, hvad er så risikoen for neurologiske skader?”
Det er der selvsagt ikke noget klart svar på, og vi ved også alle, at der er enorme forskelle fra barn til barn.
Men nu er der kommet et nyt studie fra Sverige, der via epidemiologiske data, estimerer risikoen for cerebral parase (CP) og epilepsi afhængig af APGAR-score efter 5 og 10 minutter.
Sverige er et sundhedsvæsen meget sammenligneligt med vores, hvorfor data og resultater i høj grad må forventes at kunne ekstrapoleres til Danmark.
Det er et ganske stort studie med data fra over 1.2 millioner nyfødte, født fra 1999-2012 (kun singletons). 1221 (0.1%) af børnene blev diagnosticeret med CP og 3975 (0.3%) med epilepsi.
Der var en klar sammenhæng mellem lav APGAR-score og risikoen for både CP og epilepsi. F.eks. havde APGAR 7-8 ved 5 minutter og 9-10 ved 10 minutter en hazard ratio på 2.2, mens hazard ratio var 5.3, hvis APGAR også efter 10 minutter forblev 7-8.
Studiet har ligefrem flottet sig med et ”flowchart”, der viser hazard ratios afhængig af APGAR score ved både 5 og 10 minutter
(http://www.bmj.com/content/bmj/suppl/2018/02/07/bmj.k207.DC2/perm041353.ww2.pdf).
Måske ikke ligefrem noget man kan hive frem og gennemgå med de nybagte forældre, men det giver et godt overblik og kan derved danne grundlag for den viden, man senere skal formidle til familierne.
Som ekstra lille godbid er der i resultatafsnittet en fin gennemgang af ”risiko-karakteristika” for både mor og barn for risikoen for lav APGAR.
God fornøjelse med læsningen, Mikel Alberdi-Saugstrup
360 doi: https://doi.org/10.1136/bmj.k207 (Published 08 February 2018)
Abstract
OBJECTIVE To investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks.
DESIGN, SETTING AND PARTICIPANTS Population based cohort study in Sweden, including 1 213 470 non-malformed live singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries.
EXPOSURES Apgar scores at five and 10 minutes.
MAIN OUTCOME MEASURE Cerebral palsy and epilepsy diagnosed up to 16 years of age. Adjusted hazard ratios were calculated, along with 95% confidence intervals.
RESULTS 1221 (0.1%) children were diagnosed as having cerebral palsy and 3975 (0.3%) as having epilepsy. Compared with children with an Apgar score of 10 at five minutes, the adjusted hazard ratio for cerebral palsy increased steadily with decreasing Apgar score: from 1.9 (95% confidence interval 1.6 to 2.2) for an Apgar score of 9 to 277.7 (154.4 to 499.5) for an Apgar score of 0. Similar and even stronger associations were obtained between Apgar scores at 10 minutes and cerebral palsy. Associations between Apgar scores and epilepsy were less pronounced, but increased hazard ratios were noted in infants with a five minute Apgar score of 7 or less and a 10 minute Apgar score of 8 or less. Compared with infants with an Apgar of 9-10 at both five and 10 minutes, hazard ratios of cerebral palsy and epilepsy were higher among infants with a five minute Apgar score of 7-8 and a 10 minute Apgar score of 9-10.
CONCLUSION Risks of cerebral palsy and epilepsy are inversely associated with five minute and 10 minute Apgar scores across the entire range of Apgar scores.