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Authors
Advisor(s)
Abstract(s)
Introdução: O índice de Apgar é um método de avaliação vital do recém-nascido, traduzindo
a adaptação imediata do feto à vida extrauterina. É considerada uma adaptação normal o
resultado igual ou superior a 7. O principal interesse deste critério é orientar quem assiste o
parto sobre a eventual necessidade de executar manobras de reanimação.
Objetivo: Estabelecer a relação entre o índice de Apgar e o risco de comorbilidades no
recém-nascido, comparando os recém-nascidos com índice de Apgar inferior a 7 com aqueles
cujo índice de Apgar foi igual ou superior a 7, ao 5º minuto.
Metodologia: Estudo observacional retrospetivo com 284 bebés (23 com índice de Apgar <7 e
261 com índice de Apgar =7 ao 5ºminuto), cujo nascimento ocorreu entre janeiro de 2016 e
dezembro de 2017, no Centro Hospitalar Universitário Cova da Beira. Os dois grupos foram
comparados em relação a três conjuntos de variáveis: características maternas (idade e
qualidade de vigilância da gravidez), características próprias do recém-nascido (género,
gemelaridade, tipo de parto, idade gestacional e peso ao nascimento) e características do
período neonatal (necessidade de reanimação avançada, hipoglicémia, intolerância alimentar,
necessidade de oxigénio, antibioterapia, convulsões, insuficiência respiratória, fototerapia,
infeções, uso de aminas vasoativas, malformações associadas, insuficiência renal e o tempo
de internamento). Os dados foram recolhidos a partir dos processos clínicos dos
recém-nascidos e respetivas mães. Utilizou-se o software SPSSv25.0 para a análise estatística
dos dados. Considerou-se o nível de significância de 5%.
Resultados: Em relação às características maternas avaliadas, não foram encontradas
relações estatisticamente significativas. A avaliação das variáveis relativas ao recém-nascido
mostrou que índice de Apgar <7 está associado a maior predisposição para apresentar baixo
peso ao nascer, parto por cesariana, gemelaridade e prematuridade. Adicionalmente, foi
observado que, durante o período neonatal, estes recém-nascidos têm frequências mais altas
de reanimação avançada (26,1 vs 0,4%), hipoglicémia (39,1 vs 16,5%), intolerância alimentar
(60,9 vs 4,2%), necessidade de oxigénio (65,2 vs 1,5%), necessidade de antibioterapia (34,8 vs
0,8%), convulsões (13,0 vs 0,4%), insuficiência respiratória (91,3 vs 2,3%), necessidade de
fototerapia (39,1 vs 8,4%) e uso de aminas vasoativas (17,4 vs 1,1%). Nenhum recém-nascido,
em nenhum dos grupos, apresentou infeção, malformações associadas ou insuficiência renal.
O tempo de internamento foi superior no grupo de recém-nascidos com índice de Apgar <7,
com média de 5,26 dias.
Conclusão: Embora a prevalência de índice de Apgar <7 tenha sido de apenas 8,1%, as
complicações neonatais foram observadas em mais de metade desses recém-nascidos.
Portanto, há necessidade de avaliar e monitorizar cuidadosamente esses bebés
imediatamente após o nascimento. Neste contexto, torna-se fundamental a implementação de normas orientadoras da assistência a estes recém-nascidos, assim como a formação de
equipas capazes de identificar as suas necessidades, desde a sala de partos até à alta
hospitalar.
Introduction: The Apgar score is a method of the newborn’s vital assessment, translating the fetus’ immediate adaptation to the extrauterine life. It is considered a normal adjustment a score equal or greater than 7. This criteria’s main interest is to provide guidance to the person giving assistance to the childbirth regarding the eventual need to execute resuscitation maneuvers. Objective: Establish the relation between the Apgar score and the risk of comorbidities in the newborn, comparing newborns with a score below 7 with those whose score was equal or greater than 7 at the fifth minute. Methodology: Retrospective observational study with 284 babies (23 with Apgar score <7 and 261 with Apgar score =7 at the fifth minute) whose birth occurred between January 2016 and December 2017 at CHUCB. The two groups were compared regarding three sets of variables: maternal characteristics (age and pregnancy surveillance’s quality), newborn’s characteristics (gender, twinning, delivery method, gestational age and birth weight) and characteristics of the neonatal period (need for advanced resuscitation, hypoglycemia, feeding problems, oxygen need, antibiotic therapy, seizures, respiratory failure, phototherapy, infections, use of vasoactive amines, associated malformations, renal insufficiency and length of stay). The data was collected from the newborns’ files and from their mothers’. Software SPSSv25.0 was used to the statistical analysis. It was considered a significance level of 5%. Results: Regarding the accessed mothers’ characteristics there weren’t any statistically meaningful relationships. The assessment of the newborn’s variables showed that an Apgar score <7 is associated with higher risk of low birth weight, caesarean delivery, twinning and prematurity. Additionally, it was noticed that, during the neonatal period, these newborns have higher rates of advanced resuscitation (26,1 vs 0,4%), hypoglycemia (39,1 vs 16,5%), feeding problems (60,9 vs 4,2%), oxygen need (65,2 vs 1,5%), need of antibiotics (34,8 vs 0,8%), seizures (13,0 vs 0,4%), respiratory failure (91,3 vs 2,3%), phototherapy need (39,1 vs 8,4%) and use of vasoactive amines (17,4 vs 1,1%). None of the newborns presented infection, associated malformations or renal insufficiency on either group. Length of stay was bigger on the group of newborns with Apgar score <7, with an average of 5,26 days. Conclusion: Although the Apgar score <7 prevalence was only 8,1%, the neonatal complications were observed in more than half of these newborns. Therefore, there is the need to access and closely monitor these babies immediately after birth. Accordingly, it is pressing the implementation of rules to guide the newborns’ assistance as well as the need to educate suitable teams able to identify their necessities from the delivery room to discharge.
Introduction: The Apgar score is a method of the newborn’s vital assessment, translating the fetus’ immediate adaptation to the extrauterine life. It is considered a normal adjustment a score equal or greater than 7. This criteria’s main interest is to provide guidance to the person giving assistance to the childbirth regarding the eventual need to execute resuscitation maneuvers. Objective: Establish the relation between the Apgar score and the risk of comorbidities in the newborn, comparing newborns with a score below 7 with those whose score was equal or greater than 7 at the fifth minute. Methodology: Retrospective observational study with 284 babies (23 with Apgar score <7 and 261 with Apgar score =7 at the fifth minute) whose birth occurred between January 2016 and December 2017 at CHUCB. The two groups were compared regarding three sets of variables: maternal characteristics (age and pregnancy surveillance’s quality), newborn’s characteristics (gender, twinning, delivery method, gestational age and birth weight) and characteristics of the neonatal period (need for advanced resuscitation, hypoglycemia, feeding problems, oxygen need, antibiotic therapy, seizures, respiratory failure, phototherapy, infections, use of vasoactive amines, associated malformations, renal insufficiency and length of stay). The data was collected from the newborns’ files and from their mothers’. Software SPSSv25.0 was used to the statistical analysis. It was considered a significance level of 5%. Results: Regarding the accessed mothers’ characteristics there weren’t any statistically meaningful relationships. The assessment of the newborn’s variables showed that an Apgar score <7 is associated with higher risk of low birth weight, caesarean delivery, twinning and prematurity. Additionally, it was noticed that, during the neonatal period, these newborns have higher rates of advanced resuscitation (26,1 vs 0,4%), hypoglycemia (39,1 vs 16,5%), feeding problems (60,9 vs 4,2%), oxygen need (65,2 vs 1,5%), need of antibiotics (34,8 vs 0,8%), seizures (13,0 vs 0,4%), respiratory failure (91,3 vs 2,3%), phototherapy need (39,1 vs 8,4%) and use of vasoactive amines (17,4 vs 1,1%). None of the newborns presented infection, associated malformations or renal insufficiency on either group. Length of stay was bigger on the group of newborns with Apgar score <7, with an average of 5,26 days. Conclusion: Although the Apgar score <7 prevalence was only 8,1%, the neonatal complications were observed in more than half of these newborns. Therefore, there is the need to access and closely monitor these babies immediately after birth. Accordingly, it is pressing the implementation of rules to guide the newborns’ assistance as well as the need to educate suitable teams able to identify their necessities from the delivery room to discharge.
Description
Keywords
Chucb Comorbilidades Índice de Apgar Neonatologia Recém-Nascido Risco Neonatal