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Response to resuscitation of the newborn: Early prognostic variables
Author(s) -
Didrik Saugstad Ola,
Ramji Siddarth,
Rootwelt Terje,
Vento Maximo
Publication year - 2005
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2005.tb02007.x
Subject(s) - medicine , apgar score , resuscitation , heart rate , depression (economics) , pediatrics , mortality rate , anesthesia , encephalopathy , birth weight , cardiology , blood pressure , pregnancy , genetics , macroeconomics , economics , biology
Aim: To characterize the development of clinically relevant variables the first minutes after birth and identify early prognostic markers in newborn infants requiring resuscitation. Methods: A database of 591 infants resuscitated with either 21% or 100% oxygen was analysed. Time to first breath, development in heart rate, Apgar scores, arterial oxygen saturation (SaO 2 ), and base deficit (BD) are described in relation to different degrees of birth depression and outcomes. Results: Heart rate and Apgar scores increased quickly even in the most depressed infants but were significantly lower in those having a poor outcome. By contrast, BD normalized at the same rate, 6–7 mmol/l/h, in the first hour of life regardless of the degree of birth depression and outcome. SaO 2 values increased as quickly in room air as in 100%‐oxygen‐resuscitated infants. Time to first breath was prolonged threefold, from 1 to 3 min, in the most depressed (1‐min Apgar score <4) compared with the less depressed infants. Highest odds ratio (OR) for death in the first week of life or for development of hypoxic‐ischaemic encephalopathy (HIE) stage 2 and 3 was a 5‐min heart rate 60 bpm (OR 16.5 for both death and HIE) and Apgar <4 (OR 14 and 18.8). Neonatal survival for HIE stage 1, 2, and 3 was 93%, 63%, and 11%, respectively. OR for early neonatal death, if SaO 2 60% at 1 min, was 8.6 (sensitivity 0.82 and specificity 0.65). Conclusion: Apgar scores, heart rate, SaO 2 , and time to first breath in newly born infants in need of resuscitation may be used for early identification of infants with a poor prognosis. These data may be helpful in describing the severity of depression in single infants and to select infants in need of interventional therapy.