Outcomes related to 10-min Apgar scores of zero in Japan

Abstract

ObjectiveApgar scores of zero at 10 min strongly predict mortality and morbidity in infants. However, recent data reported improved outcomes among infants with Apgar scores of zero at 10 min. We aimed to review the mortality rate and neurodevelopmental outcomes of infants with Apgar scores of zero at 10 min in Japan.DesignObservational study.PatientsTwenty-eight of 768 infants registered in the Baby Cooling Registry of Japan between 2012 and 2016, at >34 weeks’ gestation, with Apgar scores of zero at 10 min who were treated with therapeutic hypothermia.InterventionsWe investigated the time of first heartbeat detection in infants with favourable outcomes and who had neurodevelopmental impairments or died.Main outcome measuresClinical characteristics, mortality rate and neurodevelopmental outcomes at 18–22 months of age were evaluated.ResultsNine (32%) of the 28 infants died before 18 months of age; 16 (57%) survived, but with severe disabilities and 3 (11%) survived without moderate-to-severe disabilities. At 20 min after birth, 14 of 27 infants (52%) did not have a first heartbeat, 13 of them died or had severe disabilities and one infant, who had the first heartbeat at 20 min, survived without disability.ConclusionOur study adds to the recent evidence that neurodevelopmental outcomes among infants with Apgar scores of zero at 10 min may not be uniformly poor. However, in our study, all infants with their first heartbeat after 20 min of age died or had severe disabilities.

Three-year outcome following neonatal encephalopathy in a high-survival cohort

“…In the current study, the rate of major disability among survivors of severe encephalopathy was 73.5%, which was relatively higher than the morbidity rate (36.8%) reported in a previous study 5 . The association of severe encephalopathy with the combination of low mortality (32%) and high morbidity (57%, severe disabilities) was also observed in a previous study conducted among severely asphyxiated infants (10-min Apgar scores of zero) in Japan 11 . These findings may be attributed to the reluctance among physicians in Japan to withdraw intensive life support, even in the most severe cases of encephalopathy.…”

“…The majority of deaths (82.4% and 86.1% of deaths following moderate and severe encephalopathy, respectively) occurred after the withdrawal of life-sustaining support 21 . Although our current study did not collect information regarding withdrawal of intensive life support, our prior study showed that even among infants with most severe encephalopathy (with 10-min Apgar scores of zero), only 2 of the 9 (22.2%) died following withdrawal 11 . In the current study, the rate of major disability among survivors of severe encephalopathy was 73.5%, which was relatively higher than the morbidity rate (36.8%) reported in a previous study 5 .…”

“…A lower mortality rate (7.5%) and similar composite adverse outcome rate (29.5%) were reported in a study assessing 18-month follow-up data from the Japanese national registry 7 . Furthermore, a subgroup analysis of infants with a 10-min Apgar score of zero from the same registry indicated a relatively low mortality rate (32% versus 48–54% in previous studies), as well as a high incidence of moderate to severe neurological impairments among survivors (84% versus 42–55% in previous studies) 8 – 11 . The relatively low mortality and high morbidity rates observed in the survivors were attributed to the cultural and ethical norms in Japan, where physicians rarely propose the withdrawal of intensive life support, even for infants with the most severe degrees of HIE 11 .…”

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…Ayerapetyan, 2019 116 Kasdorf, 2015 107 Natarajan, 2013 108 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 116 Casalaz, 1998 104 Harrington, 2007 103 Kasdorf, 2015 107 Natarajan, 2013 108 Patel, 2004 114 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 104 Harrington, 2007 103 Shah, 2015 110 Sproat, 2017 111 Zhang, 2019 117 Zhong, 2019 113 Note: Neurodevelopmental outcomes in postdischarge follow-up were reported in 13 studies using structured exams. 103,104,106À 112,114 À 117 In 11 studies, these assessments used validated developmental assessment tools.…”

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation

“…In previous studies about the prognosis of newborns who underwent CPR for ≥ 10 minutes after delivery, the proportion of those admitted to the neonatal intensive care unit and the proportion of surviving newborns were significantly different depending on the studies. [209][210][211][212][213][214][215][216][217][218][219][220][221][222] Newborns who underwent CPR for ≥ 10-20 minutes immediately after birth and did not show recovery of spontaneous circulation had a high risk of mortality and moderate-to-severe neurological impairment even if they survived. However, there is currently no evidence that a specific CPR duration is associated with death or neurological sequelae.…”