Influence of maternal and perinatal complications on therapeutic hypothermia in newborns with low Apgar scores

Carlstron, Pedro Teodoro; Augusto, Marina Nóbrega; Peixoto, Alberto Borges; Araujo Júnior, Edward; Mello, Nathalia; Mattar, Rosiane; Sun, Sue Yazaki

doi:10.1590/1806-9282.20231525

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 70 (7) • 2024 • https://doi.org/10.1590/1806-9282.20231525 copy

Influence of maternal and perinatal complications on therapeutic hypothermia in newborns with low Apgar scores

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the impact of therapeutic hypothermia on maternal and perinatal outcomes in newborns with Apgar score<7 at the 5th min.

METHODS:

A retrospective cohort study was carried out with 55 newborns who had an Apgar score<7 at the 5th min (35 without and 20 with therapeutic hypothermia) from low-risk pregnancies between 33 and 41 weeks gestation. The Apgar score was calculated through an objective assessment by a neonatologist in the delivery room. Therapeutic hypothermia was indicated by a neonatologist in the delivery room, according to the protocol established by the Brazilian Society of Pediatrics. The maternal and perinatal outcomes of both groups (without and with therapeutic hypothermia) were compared.

RESULTS:

A rate of Apgar score<7 at the 5th min was 1.02%. No statistical differences were observed between the two groups (without and with therapeutic hypothermia) regarding maternal/perinatal complications. The presence of maternal/perinatal complications did not increase the odds ratio of neonatal therapeutic hypothermia in newborns with Apgar score<7 at the 5th min.

CONCLUSION:

The rate of Apgar score<7 at the 5th min was low, and it was not associated with any maternal/perinatal complications. There was no significant difference in maternal/perinatal complications between newborns who received therapeutic hypothermia and those who did not.

KEYWORDS:
Newborn; Apgar score; Therapeutic hypothermia

		Group I (n=35)	Group II (n=20)	p-value
Maternal age (years)
	<18	0.0% (0/34)	5.3% (1/19)	0.358^§ § percentage (n/N); p<0.05.
	18–35	82.4% (28/34)	68.4% (13/19)	0.311^§ § percentage (n/N); p<0.05.
	>35	17.6% (6/34)	26.3% (5/19)	0.495^§ § percentage (n/N); p<0.05.
	BMI (kg/m²)	26.0 (22.0–34.0)	27.0 (24.0–36.0)	0.096^∫ ∫ median (minimum–maximum); Chi-square
	Number of pregnancies	1 (1–5)	1 (1–5)	0.984^∫ ∫ median (minimum–maximum); Chi-square
Number of previous deliveries
	Nulliparous	54,3% (19/35)	50.0% (10/20)	0.759^§ § percentage (n/N); p<0.05.
	Multiparous	45.3% (16/35)	50.0% (10/20)	0.759^§ § percentage (n/N); p<0.05.
	Gestational age (weeks)	39.0 (33.0–41.0)	40.0 (38.0–41.0)	0.166^∫ ∫ median (minimum–maximum); Chi-square
	Prematurity	11.8% (4/34)	0.0% (0/19)	0.120^§ § percentage (n/N); p<0.05.
	Arterial hypertension during pregnancy	8.8% (3/34)	5.3% (1/19)	0.638^§ § percentage (n/N); p<0.05.
	Gestational diabetes mellitus	8.8% (3/34)	5.3% (1/19)	0.638^§ § percentage (n/N); p<0.05.
	Fetal growth restriction	0.0% (0/35)	0.0% (0/20)
	Positive culture for GBS	11.8% (4/34)	10.5% (2/19)	0.945^§ § percentage (n/N); p<0.05.
	PPROM	8.8% (3/34)	22.2% (4/18)	0.178^§ § percentage (n/N); p<0.05.
Characteristics of amniotic fluid
	Clear	61.3% (19/31)	75.0% (12/16)	0.517^§ § percentage (n/N); p<0.05.
	Fluid meconium	9.7% (3/31)	0.0% (0/16)	0.541^§ § percentage (n/N); p<0.05.
	Thick meconium	25.8% (8/31)	25.0% (4/16)	>0.999^§ § percentage (n/N); p<0.05.
	Blood	3.2% (1/31)	0.0% (0/16)	>0.999^§ § percentage (n/N); p<0.05.
Labor
	Spontaneous	76.5% (26/34)	61.1% (11/18)	0.336^§ § percentage (n/N); p<0.05.
	Induced	23.5% (8/34)	38.9% (7/19)	0.336^§ § percentage (n/N); p<0.05.
Type of delivery
	Vaginal	44.1% (15/34)	52.6% (10/19)	0.579^§ § percentage (n/N); p<0.05.
	Forceps	0.0% (0/34)	0.0% (0/19)
	Cesarean section	55.9% (19/34)	47.4% (9/19)	0.579^§ § percentage (n/N); p<0.05.
Birth weight
	<2,500 g	23.5% (8/34)	5.3% (1/19)	0.133^§ § percentage (n/N); p<0.05.
	2,500–4,000 g	70.6% (24/34)	84.2% (16/19)	0.334^§ § percentage (n/N); p<0.05.
	>4,000 g	5.9% (2/34)	10.5% (2/19)	0.611^§ § percentage (n/N); p<0.05.
	Apgar score at the 1st min	3.0 (0.0–8.0)	2.0 (0.0–5.0)	0.185^∫ ∫ median (minimum–maximum); Chi-square
	NICU admission	100.0% (35/35)	100% (20/20)
	NICU length (days)	3.0 (1.0–19.0)	7.0 (1.0–30.0)	0.032^∫ ∫ median (minimum–maximum); Chi-square
	Invasive ventilation support (h)	5.5 (0–456.0)	24.0 (0–480.0)	0.117^∫ ∫ median (minimum–maximum); Chi-square
	Use of antibiotics	30.3% (10/33)	42.1% (8/19)	0.389^§ § percentage (n/N); p<0.05.
	Vasoactive drug	28.1% (9/32)	57.9% (11/19)	0.035^§ § percentage (n/N); p<0.05.
	Blood transfusion	18.2% (6/33)	15.8% (3/19)	0.826^§ § percentage (n/N); p<0.05.
	Intracranial hemorrhage	6.3% (2/32)	26.3% (5/19)	0.044^§ § percentage (n/N); p<0.05.
	Neonatal death	5.7% (2/35)	5.0% (1/20)	0.911^§ § percentage (n/N); p<0.05.

Variable		OR	95%CI	p-value^§ § Chi-square.
Prematurity		0.174	0.009–3.41	0.120
Arterial hypertension during pregnancy		0.574	0.055–5.94	0.638
Gestational diabetes mellitus		0.574	0.055–5.94	0.638
Positive culture for GBS		0.95	0.159–5.01	0.945
PPROM		2.95	0.582–15.0	0.178
Characteristics of amniotic fluid
	Clear	1.89	0.533–6.26	0.517
	Fluid meconium	0.00	0–2.20	0.541
	Thick meconium	0.95	0.27–3.96	>0.999
	Blood	0.00	0–17.44	>0.999
Beginning of labor
	Spontaneous	0.48	0.142–1.68	0.336
	Induced	2.06	0.592–7.02	0.336
Type of delivery
	Vaginal	1.40	0.438–4.11	0.579
	Cesarean section	0.71	0.243–2.28	0.579
Birth weight
	<2,500 g	0.18	0.015–1.16	0.133
	2,500–4,000 g	2.22	0.568–8.33	0.334
	>4,000 g	1.88	0.272–12.67	0.611
	NICU length	1.09	1.00–1.19	0.051
	Invasive ventilation support	1.00	0.99–1.08	0.183
	Use of antibiotics	1.67	0.51–5.42	0.389
	Vasoactive drug	3.51	1.07–11.6	0.039
	Blood transfusion	0.84	0.18–3.85	0.826
	Intracranial hemorrhage	5.36	0.92–31.08	0.061

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[1] *Corresponding author: araujojred@terra.com.br