BACKGROUND: Although the influence of maternal distress during pregnancy on newborn Apgar scores has been studied in various populations, there is limited research specifically addressing this issue among Asian women. This study of Japanese women aims to investigate the association between maternal distress during pregnancy and the risk of a low 5-min-Apgar score among newborns. METHODS: We analyzed data from 87,765 mother-newborn pairs in the Japan Environment and Children's Study. Using multivariable logistic regression, we estimated odds ratios (OR) and 95% confidence intervals (CI) for low Apgar scores (<7) at 5 minutes about maternal distress during early and mid-late pregnancy, as measured by the Kessler Psychological Distress Scale (K6). Apgar scores were obtained from newborns' medical records. RESULTS: A higher risk of low Apgar score in newborns at 5 minutes was found in mothers with moderate to severe distress than in those with low distress during mid-late pregnancy. The adjusted OR (95% CI) was 1.22 (1.05-1.42) for moderate distress (K6 = 5-12) and 1.42 (1.00-2.01) for severe distress compared to low distress (p for trend = 0.002). The positive association between maternal distress and the risk of low Apgar score was observed in preterm birth (<37 weeks) and low birth weight (<2,500 g) but not in term birth and normal birth weight. CONCLUSION Maternal distress during mid-late pregnancy was positively associated with the risk of low Apgar score of newborns, specifically in preterm birth and low birth weight.
Humans ; Female ; Pregnancy ; Japan/epidemiology* ; Apgar Score ; Infant, Newborn ; Adult ; Stress, Psychological/epidemiology* ; Male ; Young Adult ; Pregnancy Complications/epidemiology* ; Mothers/psychology* ; Risk Factors

OBJECTIVES: To study the treatment outcomes of extremely preterm infants. METHODS: A retrospective analysis was performed for the clinical data of extremely preterm infants who were admitted to the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2022. The infants were divided into a non-in-hospital death group and a survival group. SPSS 29.0 was used for data analysis. RESULTS: A total of 422 extremely preterm infants were included, of which 155 were in the non-in-hospital death group and 267 in the survival group. The gestational age, birth weight, cesarean section rate, and proportion of mothers with premature rupture of membranes >18 hours in the non-in-hospital death group were all lower than those in the survival group (P<0.05). In contrast, the proportions of Apgar score ≤3 at 1 minute, intubation, neonatal respiratory distress syndrome, early-onset sepsis, periventricular-intraventricular hemorrhage (grades III-IV), and pneumorrhagia were higher in the non-in-hospital death group compared to the survival group (P<0.05). CONCLUSIONS Low gestational age, low birth weight, the history of birth asphyxia, severe intracranial hemorrhage, and pneumorrhagia may be the main causes of non-in-hospital death in extremely preterm infants, and therefore, perinatal health care should be enhanced to reduce the onset of asphyxia and severe diseases.
Humans ; Infant, Extremely Premature ; Infant, Newborn ; Female ; Retrospective Studies ; Male ; Treatment Outcome ; Gestational Age ; Apgar Score ; Birth Weight ; Respiratory Distress Syndrome, Newborn/mortality*

OBJECTIVES: To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants. METHODS: This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants. RESULTS: The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05). CONCLUSIONS Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.
Female ; Humans ; Infant ; Infant, Newborn ; Pregnancy ; Abruptio Placentae/epidemiology* ; Apgar Score ; Breech Presentation ; Case-Control Studies ; Placenta ; Pregnancy Complications/epidemiology* ; Risk Factors ; Stillbirth

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.
Apgar Score ; Child ; Child, Preschool ; China ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Resuscitation ; Risk Factors

OBJECTIVE: To investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure. METHODS: The medical data of 2 525 neonates with respiratory failure were retrospectively studied, who were reported in 30 hospitals of Jiangsu Province from January to December, 2019. According to whether a complete treatment was given, they were divided into a complete treatment group with 2 162 neonates and a withdrawal group with 363 neonates. A multivariate logistic regression analysis was used to investigate the factors contributing to the withdrawal from treatment in neonates with respiratory failure. RESULTS: The multivariate logistic regression analysis showed that small-for-gestational-age birth, congenital abnormality, gestational age < 28 weeks, living in the rural area or county-level city, and maternal age < 25 years were risk factors for the withdrawal from treatment in neonates with respiratory failure ( CONCLUSIONS Small-for-gestational-age birth, congenital abnormality, gestational age, living area, maternal age, Apgar score at birth, and method of birth are contributing factors for the withdrawal from treatment in neonates with respiratory failure. A poor prognosis and a low quality of life in future might be major immediate causes of withdrawal from treatment in neonates with respiratory failure, which needs to be confirmed by further studies.
Apgar Score ; Cesarean Section ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Pregnancy ; Quality of Life ; Respiratory Insufficiency/therapy* ; Retrospective Studies ; Risk Factors

Objective Neuraxial block is the most common anesthesia method for cesarean section (CS). However, for some urgent and high-risk cesarean delivery, general anesthesia (GA) also plays a very important role. We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes. Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1, 2014 to December 31, 2016. Clinical data (baseline maternal status, preoperative status, perioperative information, maternal and fetal outcomes) of parturients and neonates were collected and analyzed. We summarized the common reasons for applying general anesthesia, and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists (ASA) grade, gestational weeks and intraoperative blood loss, as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks. Results There were 98 cases of CS under GA enrolled in the study. Among the maternal and fetal factors, pregnancy with internal or surgical diseases is the most common reason (59 cases, 60.2%) for choosing GA, followed by the placenta and fetal membrane abnormalities (38 cases, 38.8%) and the pregnancy-specific disorders (36 cases, 36.7%). ASA grade Ⅲ-Ⅳ of parturients (χ ²=44.3, P<0.05), gestation period < 37 weeks (χ ²=23.4, P<0.05), and blood loss > 800 ml (χ ²=5.5, P<0.05) were related to the higher postoperative intensive care unit (ICU) rate in parturients. ASA grade Ⅲ-Ⅳ of parturients (t=-2.99, P<0.05), gestation period < 37 weeks (t=2.47, P<0.05) were related to the longer hospital stay. ASA grade Ⅲ-Ⅳ of parturients (t=2.21, P=0.01) and gestation period < 37 weeks (t=-3.21, P=0.002) were related to the lower one-minute Apgar score of neonates. Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS. High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.
Adolescent ; Adult ; Anesthesia, General ; Apgar Score ; Blood Loss, Surgical ; Cesarean Section ; Female ; Humans ; Infant, Newborn ; Middle Aged ; Pregnancy ; Retrospective Studies ; Young Adult

PURPOSE: This study was conducted to evaluate cognitive ability in preschoolers born prematurely and to investigate related factors.METHODS: A prospective, longitudinal study was conducted with 64 children at 5–6 years of corrected age (CA) (second follow-up) among 76 children who had been assessed at 2.0~3.5 years of CA (first follow-up) from a sample of 343 preterm infants born from 2008 to 2010. To evaluate each child's cognitive ability, during a home visit, we used the Kaufman Assessment Battery for Children-II (KABC-II) at the second follow-up. To explore factors related to cognitive ability, we measured children's hemoglobin level at the second follow-up and used the data collected in our previous study, including the Bayley Scale of Infant Development-II (BSID-II) at the first follow-up.RESULTS: The mean total KABC-II quotient was 117.0±14.4. The 5-minute Apgar score (β=.29, p=.006), hemoglobin level (β=.22, p=.032), and the mental development index quotient of the BSID-II (β=.51, p<.001) were statistically significant predictors of the KABC-II quotient in multiple linear regression analysis.CONCLUSION: The cognitive function of young children born prematurely was influenced by early neurodevelopment and factors reflecting their health status, such as anemia and a low 5-minute Apgar score.
Anemia ; Apgar Score ; Child ; Child Development ; Cognition ; Follow-Up Studies ; House Calls ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Linear Models ; Longitudinal Studies ; Premature Birth ; Prospective Studies

PURPOSE: This study aims to investigate the effects of waterbirth on the maternal delivery process and its safety on the newborn babies. METHODS: This study is a retrospective study, analyzing the medical records of pregnant women who gave birth at a natural birthing center in Seoul, Republic of Korea. The study compared and analyzed a total of 1,907 medical records of pregnant women, composed of 539 women who used a birthing pool and 1,160 women who did not use a birthing pool from 2015 to 2017. The collected data were analyzed by the chi-square test, Mann-Whitney U-test and Fisher exact test using SPSS ver. 22.0. The results are shown in the table below. RESULTS: The cesarean section rate was lower in the birthing pool use group, compared to the non-birthing pool use group (p=0.038), with the significantly lower cesarean section rate in birthing pool use group among primigravida women in particular (p=0.002). The birthing pool use group also used oxytocin less frequently than the non-birthing pool use group (p=0.001) And especially in primigravida women, the second stage of delivery in birthing pool use group was found to be shorter than that of the non-birthing pool use group (p=0.045). There were no significant differences in the neonatal Apgar score and the neonatal intensive care unit admission rate between the 2 groups. CONCLUSION: This study has its meaning as the first report in Korea that analyzes the effects of waterbirth on the maternal delivery process and its safety on the newborn babies.
Apgar Score ; Birthing Centers ; Cesarean Section ; Female ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Medical Records ; Oxytocin ; Parturition ; Pregnancy ; Pregnant Women ; Republic of Korea ; Retrospective Studies ; Seoul

BACKGROUND: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C–37.5°C. PURPOSE: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS: The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C–37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04–1.83), 1.44 (95% CI, 1.05–1.97) and 1.86 (95% CI, 1.22–2.82) for infants with admission temperatures of 36.0°C–36.4°C, 35.0°C–35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.
Apgar Score ; Birth Weight ; Body Temperature ; Bronchopulmonary Dysplasia ; Cohort Studies ; Delivery Rooms ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Hypothermia ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intubation ; Korea ; Laser Therapy ; Mortality ; Parturition ; Pregnancy ; Prospective Studies ; Retinopathy of Prematurity ; Seizures ; Sepsis

BACKGROUND: Surgical Apgar score (SAS) is a 10-point system that measures estimated blood loss, lowest heart rate and lowest mean blood pressure during surgery, and is known to be associated with postoperative complications. The purpose of this study was to evaluate the relationship between SAS and postoperative major complications in patient admitted to intensive care unit (ICU) after surgery. METHODS: We retrospectively reviewed 543 patients who were admitted to the ICU for 8 months. SAS, patient's demographics and postoperative outcomes were collected and analyzed based on anesthetic record and several medical records in an electronic chart system built in hospital. The patients were divided into three groups based on their SAS. The postoperative major complications, duration of ICU stay and duration of hospital stay were compared among the three groups. RESULTS: In the low score group, the rate emergency, trauma and hepatobiliary operation were high. In this group, the duration of ICU and hospital stay, use of mechanical ventilation and inotropic in ICU, and postoperative complication were also increased. SAS also had a weak negative correlation with ICU stay and hospital stay. Postoperative complication and mortality rate doubled when compared to reference group (SAS 7–10) according to univariate logistic regression. CONCLUSIONS: In patients admitted to ICU after surgery, SAS, which can be measured during surgery, is closely related to postoperative parameters including major complications, mortality, and ICU stay. In other words, it is thought that the postoperative outcomes can be improved through appropriate monitoring and intervention for patients with low SAS score.
Apgar Score ; Blood Pressure ; Critical Care ; Demography ; Emergencies ; Heart Rate ; Humans ; Intensive Care Units ; Length of Stay ; Logistic Models ; Medical Records ; Mortality ; Postoperative Complications ; Respiration, Artificial ; Retrospective Studies