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IMMEDIATE OUTCOME OF BABIES WITH LOW APGAR SCORE IN MULAGO HOSPITAL, UGANDA
Abstract
ABSTRACT
Background: Birth asphyxia contributes significantly to perinatal morbidity and mortality
especially in resource poor countries. Although the Apgar score has been in use for
over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome
have not been established in many sub-Saharan countries including Uganda.
Objective: To determine the prevalence of low Apgar score and establish immediate
outcome and possible risk factors for poor outcome in babies with low Apgar score.
Setting: Labour wards, operating theatres and special baby care unit, Mulago Teaching
and referral Hospital, Uganda.
Subjects: Babies delivered in Mulago Hospital between September and October 1999.
Those with low Apgar scores, together with an equal number of babies with normal
scores matched for sex as controls, were followed up for 48 hours.
Measurements: Clinical features, anthropometry, gestational age, oxygen saturation,
blood glucose and autopsy of babies who died.
Main outcome measures: Clinical improvement, death, complications such as HIE, RDS,
aspiration pneumonia, hypoglycaemia, hypothermia, hypotension and hypoxaemia.
Results: The prevalence of low Apgar score at one and five minutes was 8.4% and 2.8%
respectively. Adverse outcome was seen in 57.3% of cases: death in 12.1% and clinical
complications in 45.2%. HIE occurred in 21.8%, hypoxaemia in 12.9%, hypoglycaemia
in 16.9% and aspiration pneumonia in 4.8%. Maternal factors significantly associated
with low Apgar scores included primiparity, abnormal delivery, age and medical diseases
during pregnancy, while birth injuries and cord accidents were the baby factors. Poor
outcome was associated with birth injury, hypothermia, hypoglycaemia, hypotension,
aspiration pneumonia, hypoxaemia and severe birth asphyxia.
Conclusion: Even though the prevalence of low Apgar was only 8.4%, adverse outcomes
associated with it were observed in more than half the patients. Therefore there is need
to carefully evaluate and monitor babies with low Apgar scores immediately after birth.
Background: Birth asphyxia contributes significantly to perinatal morbidity and mortality
especially in resource poor countries. Although the Apgar score has been in use for
over 50 years, the prevalence of low Apgar score and attendant risk factors and outcome
have not been established in many sub-Saharan countries including Uganda.
Objective: To determine the prevalence of low Apgar score and establish immediate
outcome and possible risk factors for poor outcome in babies with low Apgar score.
Setting: Labour wards, operating theatres and special baby care unit, Mulago Teaching
and referral Hospital, Uganda.
Subjects: Babies delivered in Mulago Hospital between September and October 1999.
Those with low Apgar scores, together with an equal number of babies with normal
scores matched for sex as controls, were followed up for 48 hours.
Measurements: Clinical features, anthropometry, gestational age, oxygen saturation,
blood glucose and autopsy of babies who died.
Main outcome measures: Clinical improvement, death, complications such as HIE, RDS,
aspiration pneumonia, hypoglycaemia, hypothermia, hypotension and hypoxaemia.
Results: The prevalence of low Apgar score at one and five minutes was 8.4% and 2.8%
respectively. Adverse outcome was seen in 57.3% of cases: death in 12.1% and clinical
complications in 45.2%. HIE occurred in 21.8%, hypoxaemia in 12.9%, hypoglycaemia
in 16.9% and aspiration pneumonia in 4.8%. Maternal factors significantly associated
with low Apgar scores included primiparity, abnormal delivery, age and medical diseases
during pregnancy, while birth injuries and cord accidents were the baby factors. Poor
outcome was associated with birth injury, hypothermia, hypoglycaemia, hypotension,
aspiration pneumonia, hypoxaemia and severe birth asphyxia.
Conclusion: Even though the prevalence of low Apgar was only 8.4%, adverse outcomes
associated with it were observed in more than half the patients. Therefore there is need
to carefully evaluate and monitor babies with low Apgar scores immediately after birth.
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