| Abstract | Cilj istraživanja: Cilj ovog istraživanja je prikazati učestalost niske Apgar ocjene vitalnosti nakon prve i pete minute unutar definiranih kategorija i kombinacija kategorija ocjene fetalnog rasta.
Materijali i metode: Provedeno je presječno retrospektivno istraživanje terminske novorođenčadi iz jednoplodovih trudnoća u Klinici za ženske bolesti i porode KBC Split (Klinika) u razdoblju od 2003. do 2008. godine. Podaci su dobiveni iz Rađaonskih protokola Klinike. Uključene su jednoplodove donošene trudnoće, Isključena su samo malformirana, mrtvorođena, ili rano neonatalno umrla novorođenčad te porođaji s nepotpunom medicinskom dokumentacijom. Fetalni rast je kao ulazni čimbenik ocjenjivan: a) prema porođajnoj masi u odnosu na dob trudnoće, spol ploda i paritet majke (hipotrofija, eutrofija, hipertrofija), b) prema ponderalnom indeksu novorođenčadi (pothranjenost, simetričan rast, pretilost), c) kombiniranjem navedenih metoda (sveukupno devet kategorija). Apgar ocjena vitalnosti je korišten kao izlazni čimbenik istraživanja.
Rezultati: U studiju je uključeno 21410 parova majki i njihove novorođenčadi. Nisku Apgar ocjenu je imalo 425(1,98%) nakon prve i 228(1,06%) nakon pete minute. Učestalost niske Apgar ocjene eutrofičnih plodova simetričnog rasta (1,42% nakon prve i 0,72% nakon pete minute) je uzeta za referentnu vrijednost u komparaciji s ostalim kategorijama i potkategorijama ocjena fetalnog rasta. Učestalost niske Apgar ocjene je bila veća uz hipotrofiju (4,35%; χ2 = 67,54; P < 0,001; RR 2,98; 95%CI: 1,92-2,81) i hipertrofiju (2,70%; χ2 = 10,05; P < 0,001; RR=1,88; 95%CI: 1,20-2,03) nakon prve minute, jednako kao i nakon pete minute kada je za hipotrofičnu novorođenčad iznosila 2,67% (χ2 = 67,1; P < 0,001; RR 2,83; 95%CI: 2,26-3,54), a za hipertrofičnu 1,59% (χ2 = 1,94; P < 0,001; RR 1,94; 95%CI: 1,40-2,98). Frekvencija niske Apgar ocjene uz novorođenačku pothranjenost je bila 4,92% (χ2 = 151,89; P < 0,001; RR 2,53; 95%CI:2,21-2,89) nakon prve, a 2,59% (χ2 = 81,49; P < 0,001; RR 2,51; 95%CI: 2,11-2,98) nakon pete minute. Statistički značajno veća učestalost niske Apgar ocjene nakon prve minute je dokazana u novorođenčadi niskog PI u podskupinama: hipotrofične (6,81%; P < 0,001; χ2 = 158,65; RR 4,09; 95%CI: 3,29-5,10), eutrofične (3,73%; χ2 = 56,86; P < 0,001; RR 2,24; 95%CI: 1,83-2,73) i hipertrofične novorođenčadi (28%;, χ2 = 106,11; P < 0,001; RR 26,11; 95%CI: 11,04-62,0). Novorođenačka pretilost se pokazala značajnim rizičnim čimbenikom za niski Apgar nakon prve minute samo u podskupini hipertrofične novorođenčadi (3,42%; χ2 = 9,85; P = 0,002; RR 2,35; 95%CI: 1,43-3,88). Vjerojatnost niske Apgar ocjene nakon pete minute statistički je značajno veća u novorođenčadi niskog PI u podskupinama: hipotrofične (4,02%; P < 0,001; χ2 = 102,63; RR 4,43; 95%CI: 3,36-5,84) eutrofične (1,74%; P < 0,001; χ2 = 19,96; RR 2,05; 95%CI: 1,53-2,74) i hipertrofične (16%; χ2 = 58,26; P < 0,001; RR 24,89 95%CI: 8,68-71,35) novorođenčadi. Pretilost je nakon pete minute samo u podskupini hipertrofične novorođenčadi povećavala učestalost niske Apgar ocjene (2,05%; χ2 = 8,07; P = 0,004; RR 2,80; 95%CI: 1,43-5,49). Najveću vjerojatnost oporavka Apgar ocjene od niske u kategoriju urednih su imala eutrofična novorođenčad (54,6%). Hipotrofična (41,86%; χ2 = 48,74; P < 0,001; RR 0,62; 95%CI: 0,46-0,98) i hipertrofična (47,9%; χ2 = 26,36; P < 0,001; RR 0,79; 95%CI: 0,46-1,34) novorođenčad su se značajno rjeđe uspješno oporavljala od eutrofičnih. Uz simetričan rast oporavak je iznosio 51.7%. Mršava (49.3%) i pretila novorođenčadi (59.1%) su imala incidenciju oporavka bez statistički značajne razlike u odnosu na onu urednog PI.
Zaključak: Odstupanje u tjelesnoj masi i simetričnosti novorođenčeta, u samostalnim i međusobno kombiniranim kategorijama ocjene fetalnog rasta, utječe na udio onih s niskom Apgar ocjenom nakon prve i pete minute, kao i na vjerojatnost oporavka unutar ispitivanog vremena. |
| Abstract (english) | Objective: The aim of this study is to show the incidence of low Apgar vitality score after the first and the fifth minute within defined categories and combinations of categories of fetal growth rating.
Materials and methods: A cross-secctional retrospective study was preformed on full-term newborn infants from singleton pregnancies, which occured in Department of Obstetrics and Gynecology of KBC Split in the period from 2003 to 2008. Data were obtained from the Birth protocol of the Clinical Center. Included were singleton full-term pregnancies. Excluded were only malformed newborns, stillborns or early neonantal dead newborns and infants with incomplete medical records. Fetal growth, as imput factor, is rated: a) according to the birth weight in relation to the age of the pregnancy, fetus gender and maternal parity (hypotrophy, eutrophy, hypertrophy), b) according to the ponderal index of newborns (malnutrition, symetrical growth, obesity), c) previous fetal growth evaluation combined (total of nine categories). Apgar vitality score was used as the output factor of the research.
Results: The study included 21410 pairs of mothers and their newborns. The low Apgar score was 425 (1.98%) after the first and 228 (1.06%) after the fifth minute. The incidence of low Apgar evaluation of eutrophic fetus of symmetric growth (1.42% after the first and 0.72% after the fifth minute) was taken for reference value in comparison with other categories and sub-categories of fetal growth rate. The incidence of low Apgar score was higher with hypotrophy (4.35%, χ2 = 67.54, P < 0.001, RR 2.98, 95% CI: 1.92-2.81) and hypertrophy (2.70%; χ2 = 10.05, P < 0.001, RR = 1.88, 95% CI: 1.20-2.03) after the first minute, as well as after the fifth minute when it was 2.67% (χ2 = 1.75; P < 0.001; RR 2.83; 95% CI: 2.26-3.54) for hypotrophic newborns and 1.59% (χ2 = 1.94, P < 0.001, RR 1.94, 95% CI: 1.40-2.98) for hypertrophic newborns. The low Apgar scor for the newborn malnutrition was 4.92% (χ2 = 151.89, P < 0.001, RR 2.53, 95% CI: 2.21-2.89) after the first and 2.59% ( χ2 = 81.49; P < 0.001; RR 2.51; 95% CI: 2.11-2.98) after the fifth minute. Statistically significantly higher incidence of low Apgar score after the first minute was demonstrated in infants of low PI in subgroups: hypotrophic (6.81%; P < 0.001; χ2 = 158.65; RR 4.09; 95% CI: 3.29-5 , 10), eutrophic (3.73%; χ2 = 56.86; P < 0.001; RR 2.24; 95% CI: 1.83-2.73) and hypertrophic newborns (28%; χ2 = 106.11 ; P < 0.001; RR 26.11; 95% CI: 11.04-62.0). Newborn obesity showed a significant risk factor for low Apgar after the first minute only in the subgroup of hypertrophic newborns (3.42%, χ2 = 9.85, P = 0.002, RR 2.35, 95% CI: 1.43-3.88 ). The probability of low Apgar score after the fifth minute is statistically significantly higher in infants of low PI in subgroups: hypotrophic (4.02%, P < 0.001, χ2 = 102.63, RR 4.43, 95% CI: 3.36-5, 84) eutrophic (1.74%; P < 0.001; χ2 = 19.96; RR 2.05; 95% CI: 1.53-2.74) and hypertrophic (16%; χ2 = 58.26; P < 0.001; RR 24.89 95% CI: 8.68-71.35) newborns. Obesity after the fifth minute in the subgroup of hypertrophic newborns increased the incidence of low Apgar score (2.05%; χ2 = 8.07; P = 0.004; RR 2.80; 95% CI: 1.43-5.49.). The highest probability of recovery of Apgar scor from the low to the appropriate had eutrophic newborns (53.6%). Hipotrophic (41.86%; χ2 = 48.74; P < 0.001; RR 0.62; 95% CI: 0.46-0 , 98) and hypertrophic (47.9%, χ2 = 26.36, P < 0.001, RR 0.79, 95% CI: 0.46-1.34), newborns were significantly less successful than eutrophic. The recovery rate was 51.7%. Skinny (49.3%) and obese newborns (59.1%) had an incidence of recovery without statistically significant difference compared to the regular IP.
Conclusion: Deviation in body mass and symmetry of newborn, in independent and mutually combined categories of fetal growth rate, affects the part of those with a low Apgar score after the first and fifth minute, as well as the probability of recovery within the examined time. |
