Newborns at a higher risk of death even if ‘normal healthy’ at birth
Babies born within a ‘normal range’ of health have a higher risk of illness, brain damage and death than infants who score a perfect 10
- Midwives assess a baby’s health condition at three points in their first ten mins
- A score of seven and above on a ten-point scale is seen as ‘normal range’
- But Swedish researchers found they are still at risk after looking at 1.5mil births
Babies considered within a ‘normal range’ of health at birth have a higher risk of illness, brain damage and death, a major study has found.
In the minutes after birth, medics assess a baby’s health – such as pulse, reactions and breathing – through an Apgar score.
Parents are reassured by midwives their child is ‘within the normal range’ if they get a score of seven and above on a ten-point scale.
But this has now been disputed by researchers who have, for the first time, investigated the health outcomes of babies in the normal range.
Babies that are considered within a ‘normal range’ of health at birth are still at a high risk of illness, brain damage and death, a large study by Swedish researchers found
Swedish scientists analysed data from more than 1.5million infants born at full term (37 weeks) between 1999 and 2016.
Infants with Apgar scores of seven to nine were compared with those with an Apgar score of ten – the highest score possible.
They have a higher risk of infection, breathing problems, and long term conditions such as epilepsy and cerebral palsy than babies who score ten.
For example, compared with a one-minute Apgar score of ten, a one-minute Apgar score of nine was associated with a 1.5-fold higher odds of infections.
As time went on, the odds grew higher – 2.1 fold at five minutes, and 3.3 fold at ten minutes, the researchers found.
However, they added the risk is still low and certainly lower than for babies with scores outside of the normal range – below seven.
WHAT DOES THE APGAR SCORE INDICATE?
The Apgar scoreis a convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed.
The Apgar score comprises five components – color, heart rate, reflexes, muscle tone and respiration. Each of these components is given a score of 0, 1, or 2 and then added to give a score from 0-10.
The score is reported at one minute and five minutes after birth for all infants, and at five-minute intervals thereafter until 20 minutes for infants with a score less than seven.
There are various recommendations for the score at each point in time and how it improves or declines.
It is important to recognise the limitations of the Apgar score. It is an expression of the baby’s condition at one point in time, which includes a lot of subjective factors.
Apgar scores do not predict individual mortality or adverse neurologic outcome.
However, based on population studies, Apgar scores of less than five at five and ten minutes clearly indicate an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy.
Most infants with low Apgar scores, however, will not develop cerebral palsy.
Source: The American Academy of Pediatrics
Dr Neda Razaz and her colleagues at the Karolinska Institutet’s published their findings in the British Medical Journal.
Writing in the publication, they added that Apgar scores in the normal range ‘are strongly associated with neonatal mortality and morbidity’.
The academics added that ‘these associations are substantially stronger with increasing time after birth’.
As well as a higher risk of infections and death, the researchers also warned babies with a ‘normal’ Apgar score faced greater odds of breathing problems and brain injuries.
The findings remained true after taking account of several factors, such as mother’s age, weight (BMI), and smoking during pregnancy.
The Apgar score is a simple way to assess a baby’s condition at birth, standing for ‘Appearance, Pulse, Grimace, Activity, and Respiration’.
At one, five and ten minutes, midwives measure the complexion, pulse rate, reaction when stimulated, muscle tone and breathing on a scale from zero to ten.
It’s a quick method – developed in the 1950s – to decide whether a baby needs immediate care in the minutes after coming out the womb.
For example, they may need a little assistance breathing with an oxygen mask, warming under a lamp or resuscitation.
Scores of less than seven don’t necessarily mean the baby will face any adverse health problems – and the score is not designed to predict long-term health outcomes.
But babies with a score below seven have been found to carry higher risks of illness or conditions such as cerebral palsy, the researchers said.
No study had previously investigated whether normal scores of seven, eight, or nine are associated with greater risk of illness or death than a perfect score of ten.
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