瑞典卡罗林斯卡大学索尔纳医院Sven Cnattingius团队分析了Apgar评分与早产儿中新生儿死亡风险的相关性。2020年7月2日，该成果发表在《新英格兰医学杂志》上。

胎龄是早产儿中新生儿死亡（出生后28天之内死亡）的主要决定因素。胎龄和Apgar评分对新生儿死亡风险的联合影响尚不清楚。

研究组使用瑞典医学出生登记数据，确定了1992-2016年出生的113300例早产儿（妊娠22周0天至36周6天）。在根据胎龄（22-24周、25-27周、28-31周、32-34周以及35-36周）进行分层的分析中，研究组根据5和10分钟时的Apgar评分以及5-10分钟之间的Apgar评分变化，来评估校正后的新生儿死亡相对风险和新生儿死亡率的绝对比率差异（即每100例婴儿中的新生儿死亡人数）。Apgar评分为0-10分，分数越高，新生儿身体状况越好。

共有1986例新生儿死亡（1.8%）。新生儿死亡的发生率从0.2%（妊娠36周）至76.5%（妊娠22周）不等。Apgar评分越低，在所有胎龄分层中新生儿死亡的相对风险越高，新生儿死亡率的绝对比率差异越大。例如，妊娠28-31周出生的婴儿中，以9-10分的婴儿为对照组，根据5分钟Apgar评分校正后的绝对率差异，0-1分时为51.7，2-3分时为25.5，4-6分时为7.1，7-8分时为1.2。与稳定的Apgar评分相比，Apgar评分在5-10分钟之间增加与新生儿死亡率较低相关。

该研究结果表明，Apgar在5和10分钟时的评分可为不同胎龄早产儿的新生儿存活预后提供有用信息。

附：英文原文

Title: Apgar Score and Risk of Neonatal Death among Preterm Infants

Author: Sven Cnattingius, M.D., Ph.D.,, Stefan Johansson, M.D., Ph.D.,, and Neda Razaz, Ph.D.

Issue&Volume: 2020-07-01

Abstract: Abstract

Background

Gestational age is the major determinant of neonatal death (death within the first 28 days of life) in preterm infants. The joint effect of gestational age and Apgar score on the risk of neonatal death is unknown.

Methods

Using data from the Swedish Medical Birth Register, we identified 113,300 preterm infants (22 weeks 0 days to 36 weeks 6 days of gestation) born from 1992 through 2016. In analyses stratified according to gestational age (22 to 24 weeks, 25 to 27 weeks, 28 to 31 weeks, 32 to 34 weeks, and 35 or 36 weeks), we estimated adjusted relative risks of neonatal death and absolute rate differences in neonatal mortality (i.e., the excess number of neonatal deaths per 100 births) according to the Apgar scores at 5 and 10 minutes and according to the change in the Apgar score between 5 minutes and 10 minutes. Scores range from 0 to 10, with higher scores indicating a better physical condition of the newborn.

Results

There were 1986 neonatal deaths (1.8%). The incidence of neonatal death ranged from 0.2% (at 36 weeks of gestation) to 76.5% (at 22 weeks of gestation). Lower Apgar scores were associated with higher relative risks of neonatal death and greater absolute rate differences in neonatal mortality in all gestational-age strata. For example, among infants born at 28 to 31 weeks, the adjusted absolute rate differences according to the 5-minute Apgar score, with those who had a score of 9 or 10 serving as the reference group, were 51.7 (95% confidence interval [CI], 38.1 to 65.4) for a score of 0 or 1, 25.5 (95% CI, 18.3 to 32.8) for a score of 2 or 3, 7.1 (95% CI, 5.1 to 9.1) for a score of 4 to 6, and 1.2 (95% CI, 0.5 to 1.9) for a score of 7 or 8. An increase in the Apgar score between 5 minutes and 10 minutes was associated with lower neonatal mortality than a stable Apgar score.

Conclusions

In this study, Apgar scores at 5 and 10 minutes provided prognostic information about neonatal survival among preterm infants across gestational-age strata.

DOI: NJ202007023830110

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1915075