Apgar Scoring System in Brazil’s Live Births Records: Differences between Home and Hospital Births

Bessa, Jordana de Faria; Bonatto, Naieli

doi:10.1055/s-0038-1675572

Jordana de Faria Bessa

Department of Gynecology, Clínica Humana, Guarulhos, SP, Brazil

https://orcid.org/0000-0002-8056-6295

Naieli Bonatto

Department of Radiology and Oncology, Universidade de São Paulo,São Paulo, SP, Brazil

Address for correspondence
Jordana de Faria Bessa, MD, Departamento de Ginecologia, Clínica Humana, Rua Barão de Mauá, 155, 07012- 040, Guarulhos, SP, Brazil (e-mail: jordana.bessa@gmail.com).

Contributors

Bessa J. F. and Bonatto N. contributed with project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.

Conflicts of Interest

None to declare.

Figures (1)
Tables (6)

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Fig. 1
Study design.

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Table 1
Characteristics of live birth population from natural birth, according to birthplace

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Table 2
Distribution of newborns according to different 1-minute Apgar score by birthplace

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Table 3
Distribution of newborns according to different 5-minute Apgar score by birthplace

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Table 4
Persistence of Apgar < 6, from 1-minute to 5-minute, by birthplace

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Score zones 0–2 3–5 6–7 8–10 Total Apgar < 6 (%) DP (MIN) DP (MAX) Birthplace Hospital 16,325 69,854 244,837 2,562,341 2,893,357 2,978512503 3,00 2,96 Home 418 159 1,009 7,475 9,061 6.37 6,89 5,88 Region North 1,222 5,015 31,052 255,767 293,056 2.13 2,18 2,08 Northeast 4,268 20,368 84,996 699,416 809,048 3.05 3,08 3,01 Southeast 7,860 31,722 85,391 1,068,795 1,193,768 3.32 3,35 3,28 South 2,458 9,036 28,842 359,634 399,970 2.87 2,93 2,82 Central-West 935 3,872 15,565 186,204 206,576 2.33 2,39 2,26 Mother's age (years) 20–24 6,228 27,522 101,832 1,027,136 1,162,718 2.90 2,93 2,87 25–29 5,159 21,497 75,590 806,489 908,735 2.93 2,97 2,90 30–34 3,546 14,236 47,743 515,317 580,842 3.06 3,11 3,02 35–39 1,810 6,758 20,681 220,874 250,123 3.43 3,50 3,35 Ethnicity White 6,079 24,773 73,893 858,056 962,801 3.20 3,24 3,17 Black 1,047 4,217 13,257 146,493 165,014 3.19 3,28 3,11 Asian 70 330 845 10,101 11,346 3.53 3,88 3,20 Mixed 8,931 38,208 149,009 1,462,282 1,658,430 2.84 2,87 2,82 Indigenous 118 459 1,801 17,243 19,621 2.94 3,19 2,71 Ignored 498 2,026 7,041 75,641 85,206 2.96 3,08 2,85 Marital status Single 7,381 30,305 104,601 1,130,868 1,273,155 2.96 2,99 2,93 Married 5,206 21,954 71,657 738,610 837,427 3.24 3,28 3,21 Widowed 32 123 460 4,933 5,548 2.79 3,26 2,39 Divorced 168 647 1,992 25,303 28,110 2.90 3,10 2,71 Consensual union 3,809 16,252 64,218 645,189 729,468 2.75 2,79 2,71 Ignored 147 732 2,918 24,913 28,710 3.06 3,27 2,87 Schooling (years) None 132 525 2,326 18,708 21,691 3.03 3,27 2,81 1–3 817 2,854 13,093 118,686 135,450 2.71 2,80 2,63 4–7 3,504 13,666 56,086 589,250 662,506 2.59 2,63 2,55 8–11 10,129 43,504 146,167 1,553,664 1,753,464 3.06 3,08 3,03 ≥ 12 1,943 8,545 24,198 256,735 291,421 3.60 3,67 3,53 Ignored 218 919 3,976 32,773 37,886 3.00 3,18 2,83 Total 16,743 70,013 245,846 2,569,816 2,902,418 2.99 3,01 2,97

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Score zones 0–2 3–5 6–7 8–10 Total Apgar < 6 (%) DP (MIN) DP (MAX) Birthplace Hospital 4,526 8,192 38,100 2,844,157 2,894,975 0.44 0,45 0,43 Home 387 52 107 8,533 9,079 4.84 5,30 4,41 Region North 537 703 3,550 287,972 292,762 0.42 0,45 0,40 Northeast 1,611 2,741 13,546 790,872 808,770 0.54 0,55 0,52 Southeast 2,070 3,324 14,459 1,175,852 1,195,705 0.45 0,46 0,44 South 384 955 4,536 394,298 400,173 0.33 0,35 0,32 Central-West 311 521 2,116 203,696 206,644 0.40 0,43 0,38 Mother's age (years) 20–24 1,865 3,131 15,171 1,142,907 1,163,074 0.43 0,44 0,42 25–29 1,597 2,475 11,767 893,421 909,260 0.45 0,46 0,43 30–34 982 1,744 7,709 570,877 581,312 0.47 0,49 0,45 35–39 469 894 3,560 245,485 250,408 0.54 0,57 0,52 Ethnicity White 1,264 2,691 11,980 947,550 963,485 0.41 0,42 0,40 Black 328 479 2,250 162,225 165,282 0.49 0,52 0,46 Asian 15 29 147 11,162 11,353 0.39 0,52 0,29 Mixed 3,086 4,765 22,552 1,628,757 1,659,160 0.47 0,48 0,46 Indigenous 73 45 200 19,285 19,603 0.6 0,72 0,50 Ignored 147 235 1,078 83,711 85,171 0.45 0,50 0,41 Marital status Single 2,190 3,537 16,481 1,251,869 1,274,077 0.45 0,46 0,44 Married 1,329 2,520 11,252 822,765 837,866 0.46 0,47 0,45 Widowed 9 17 60 5,465 5,551 0.47 0,69 0,32 Divorced 43 88 322 27,688 28,141 0.47 0,55 0,39 Consensual union 1,272 1,992 9,646 716,836 729,746 0.45 0,46 0,43 Ignored 70 90 446 28,067 28,673 0.56 0,65 0,48 Schooling (years) None 52 82 383 21,151 21,668 0.62 0,73 0,52 1–3 321 446 1,826 132,791 135,384 0.57 0,61 0,53 4–7 1,302 1,804 8,154 651,718 662,978 0.47 0,49 0,45 8–11 2,743 4,871 23,168 1,723,857 1,754,639 0.43 0,44 0,42 ≥ 12 407 899 4,142 286,094 291,542 0.45 0,47 0,42 Ignored 88 142 534 37,079 37,843 0.61 0,69 0,53 Total 4,913 8,244 38,207 2,852,690 2,904,054 0.45 0,46 0,45

Total	Hospital	Home
Total	2,955,748 (99.18%)	24,300 (0.82%)
Region
North	294,545 (96.50%)	10,673 (3.50%)
Northeast	846,091 (99.31%)	5,867 (0.69%)
Southeast	1,207,120 (99.58%)	5,097 (0.42%)
South	400,799 (99.69%)	1,238 (0.31%)
Central-West	207,193 (99.32%)	1,425 (0.68%)
Mother's age
20–24 years	1,186,664 (99.29%)	8,443 (0.71%)
25–29 years	925,778 (99.20%)	7,435 (0.80%)
30–34 years	589,634 (99.04%)	5,691 (0.96%)
35–39 years	253,672 (98.93%)	2,731 (1.07%)
Ethnicity
White	968,838 (99.48%)	5,049 (0.52%)
Black	168,745 (99.28%)	1,224 (0.72%)
Asian	11,501 (99.16%)	97 (0.84%)
Mixed	1,698,338 (99.27%)	12,441 (0.73)
Indigenous	18,988 (79.36%)	4,938 (20.64%)
Ignored	89,338 (99.39%)	551 (0.61%)
Marital status
Single	1,296,900 (99.31%)	9,067 (0.69%)
Married	849,893 (99.35%)	5,579 (0.65%)
Widowed	5,683 (99.39%)	35 (0.61%)
Divorced	28,366 (99.44%)	161 (0.56%)
Consensual union	744,315 (98.80%)	9,009 (1.20%)
Ignored	30,591 (98.55%)	449 (1.45%)
Schooling
None	22,220 (92.49%)	1,803 (7.51%)
1–3 years	139,994 (97.47%)	3,641 (2.53%)
4–7 years	678,532 (98.88%)	7,710 (1.12%)
8–11 years	1,783,070 (99.63%)	6,707 (0.37%)
≥ 12 years	291,301 (98.78%)	3,611 (1.22%)
Ignored	40,631 (98.00%)	828 (1.20%)

Birthplace	Hospital		Home
Birthplace	n	%	n	%
Apgar < 6	86,179	2.98%	577	6.37%
0–2	16,325	0.56%	418	4.61%
3–5	69,854	2.41%	159	1.75%
Apgar ≥ 6	2,807,178	97.02%	8,484	93.63%
6–7	244,837	8.46%	1,009	11.14%
8–10	2,562,341	88.56%	7,475	82.50%
Total	2,893,357	100%	9,061	100%

Birthplace	Hospital		Home
Birthplace	n	%	n	%
Apgar < 6	12,718	0.44%	439	4.84%
0–2	4,526	0.16%	387	4.26%
3–5	8,192	0.28%	52	0.57%
Apgar ≥ 6	2,882,257	99.56%	8,640	95.16%
6–7	38,100	1.32%	107	1.18%
8–10	2,844,157	98.24%	8,533	93.99%
Total	2,894,975	100%	9,079	100%

Birthplace	Hospital		Home
Birthplace	n	%	n	%
Apgar < 6	9,213	10.71%	392	71.01%
0–2	1,814	2.11%	371	67.21%
3–5	7,399	8.60%	21	3.80%
Apgar ≥ 6	76,840	89.29%	160	28.99%
6–7	27,349	31.78%	33	5.98%
8–10	49,491	57.51%	127	23.01%
Total	86,053	100%	552	100%

Score zones	0–2	3–5	6–7	8–10	Total	Apgar < 6 (%)	DP (MIN)	DP (MAX)
Birthplace
Hospital	16,325	69,854	244,837	2,562,341	2,893,357	2,978512503	3,00	2,96
Home	418	159	1,009	7,475	9,061	6.37	6,89	5,88
Region
North	1,222	5,015	31,052	255,767	293,056	2.13	2,18	2,08
Northeast	4,268	20,368	84,996	699,416	809,048	3.05	3,08	3,01
Southeast	7,860	31,722	85,391	1,068,795	1,193,768	3.32	3,35	3,28
South	2,458	9,036	28,842	359,634	399,970	2.87	2,93	2,82
Central-West	935	3,872	15,565	186,204	206,576	2.33	2,39	2,26
Mother's age (years)
20–24	6,228	27,522	101,832	1,027,136	1,162,718	2.90	2,93	2,87
25–29	5,159	21,497	75,590	806,489	908,735	2.93	2,97	2,90
30–34	3,546	14,236	47,743	515,317	580,842	3.06	3,11	3,02
35–39	1,810	6,758	20,681	220,874	250,123	3.43	3,50	3,35
Ethnicity
White	6,079	24,773	73,893	858,056	962,801	3.20	3,24	3,17
Black	1,047	4,217	13,257	146,493	165,014	3.19	3,28	3,11
Asian	70	330	845	10,101	11,346	3.53	3,88	3,20
Mixed	8,931	38,208	149,009	1,462,282	1,658,430	2.84	2,87	2,82
Indigenous	118	459	1,801	17,243	19,621	2.94	3,19	2,71
Ignored	498	2,026	7,041	75,641	85,206	2.96	3,08	2,85
Marital status
Single	7,381	30,305	104,601	1,130,868	1,273,155	2.96	2,99	2,93
Married	5,206	21,954	71,657	738,610	837,427	3.24	3,28	3,21
Widowed	32	123	460	4,933	5,548	2.79	3,26	2,39
Divorced	168	647	1,992	25,303	28,110	2.90	3,10	2,71
Consensual union	3,809	16,252	64,218	645,189	729,468	2.75	2,79	2,71
Ignored	147	732	2,918	24,913	28,710	3.06	3,27	2,87
Schooling (years)
None	132	525	2,326	18,708	21,691	3.03	3,27	2,81
1–3	817	2,854	13,093	118,686	135,450	2.71	2,80	2,63
4–7	3,504	13,666	56,086	589,250	662,506	2.59	2,63	2,55
8–11	10,129	43,504	146,167	1,553,664	1,753,464	3.06	3,08	3,03
≥ 12	1,943	8,545	24,198	256,735	291,421	3.60	3,67	3,53
Ignored	218	919	3,976	32,773	37,886	3.00	3,18	2,83
Total	16,743	70,013	245,846	2,569,816	2,902,418	2.99	3,01	2,97

Score zones	0–2	3–5	6–7	8–10	Total	Apgar < 6 (%)	DP (MIN)	DP (MAX)
Birthplace
Hospital	4,526	8,192	38,100	2,844,157	2,894,975	0.44	0,45	0,43
Home	387	52	107	8,533	9,079	4.84	5,30	4,41
Region
North	537	703	3,550	287,972	292,762	0.42	0,45	0,40
Northeast	1,611	2,741	13,546	790,872	808,770	0.54	0,55	0,52
Southeast	2,070	3,324	14,459	1,175,852	1,195,705	0.45	0,46	0,44
South	384	955	4,536	394,298	400,173	0.33	0,35	0,32
Central-West	311	521	2,116	203,696	206,644	0.40	0,43	0,38
Mother's age (years)
20–24	1,865	3,131	15,171	1,142,907	1,163,074	0.43	0,44	0,42
25–29	1,597	2,475	11,767	893,421	909,260	0.45	0,46	0,43
30–34	982	1,744	7,709	570,877	581,312	0.47	0,49	0,45
35–39	469	894	3,560	245,485	250,408	0.54	0,57	0,52
Ethnicity
White	1,264	2,691	11,980	947,550	963,485	0.41	0,42	0,40
Black	328	479	2,250	162,225	165,282	0.49	0,52	0,46
Asian	15	29	147	11,162	11,353	0.39	0,52	0,29
Mixed	3,086	4,765	22,552	1,628,757	1,659,160	0.47	0,48	0,46
Indigenous	73	45	200	19,285	19,603	0.6	0,72	0,50
Ignored	147	235	1,078	83,711	85,171	0.45	0,50	0,41
Marital status
Single	2,190	3,537	16,481	1,251,869	1,274,077	0.45	0,46	0,44
Married	1,329	2,520	11,252	822,765	837,866	0.46	0,47	0,45
Widowed	9	17	60	5,465	5,551	0.47	0,69	0,32
Divorced	43	88	322	27,688	28,141	0.47	0,55	0,39
Consensual union	1,272	1,992	9,646	716,836	729,746	0.45	0,46	0,43
Ignored	70	90	446	28,067	28,673	0.56	0,65	0,48
Schooling (years)
None	52	82	383	21,151	21,668	0.62	0,73	0,52
1–3	321	446	1,826	132,791	135,384	0.57	0,61	0,53
4–7	1,302	1,804	8,154	651,718	662,978	0.47	0,49	0,45
8–11	2,743	4,871	23,168	1,723,857	1,754,639	0.43	0,44	0,42
≥ 12	407	899	4,142	286,094	291,542	0.45	0,47	0,42
Ignored	88	142	534	37,079	37,843	0.61	0,69	0,53
Total	4,913	8,244	38,207	2,852,690	2,904,054	0.45	0,46	0,45

[1] Address for correspondence
Jordana de Faria Bessa, MD, Departamento de Ginecologia, Clínica Humana, Rua Barão de Mauá, 155, 07012- 040, Guarulhos, SP, Brazil (e-mail: jordana.bessa@gmail.com).

Brasil

Brasil

Apgar Scoring System in Brazil’s Live Births Records: Differences between Home and Hospital Births

Escala de Apgar nos registros de nascidos vivos do Brasil: discordância entre parto normal hospitalar e parto domiciliar

Abstract

Objective

Methods

Results

Conclusion