Apgar scores of seven, eight and nine (considered to be within the normal range) are associated with higher risks of illness, and even death in newborns, finds a large study from Sweden published by The BMJ on May 7, 2019.
The odds of problems are increased with “normal” scores less than 10, but the researchers stress that the risk is still low, and certainly lower than for babies with scores outside the normal range.
The Apgar score is a quick and simple way to assess a baby’s condition at birth.
The baby is assessed at one, five and 10 minutes after birth on five simple criteria (complexion, pulse rate, reaction when stimulated, muscle tone and breathing) on a scale from zero to two.
The five values are then added up to obtain an overall score from zero to 10.
Scores of less than seven are considered low and are known to carry higher risks of infections and breathing problems, as well as long term conditions such as epilepsy and cerebral palsy.
Scores of seven to 10 are considered to be “within the normal range”, and therefore, reassuring.
But no study has investigated whether normal scores of seven, eight or nine are associated with greater risk of illness or death than a perfect score of 10.
So a research team, led by Dr Neda Razaz at the Karolinska Institute, set out to compare associations between Apgar scores of seven to nine (versus 10) with illness and death in newborns.
They analysed data from more than 1.5 million Swedish infants born at fullterm between 1999 and 2016.
Infants with Apgar scores of seven, eight and nine at one, five and 10 minutes after birth were compared with those with an Apgar score of 10 at one, five and 10 minutes after birth.
After taking into account several factors, such as mother’s age, weight (body mass index) and smoking during pregnancy, the researchers found that Apgar scores of seven, eight and nine at one, five and 10 minutes after birth were strongly associated with higher risk of infections, breathing problems, brain injury as a result of oxygen deprivation, low blood sugar levels and death, compared with a consistent Apgar score of 10.
For example, compared with a one-minute Apgar score of 10, a one-minute Apgar score of nine was associated with a 1.5-fold higher odds of infections (0.8 versus 0.5 per 100 births).
At five and 10 minutes, the odds were progressively larger: 2.1-fold (1.7 versus 0.7 infections per 100 births) at five minutes, and 3.3-fold (2.9 versus 0.8 infections per 100 births) at 10 minutes.
A small change in Apgar score from 10 at five minutes to nine at 10 minutes was also associated with increased risk, compared with a stable score of 10 at five and 10 minutes.
This is an observational study, and as such, can’t establish cause, and the researchers point to some limitations, such as a lack of information about birth interventions that could influence Apgar scores.
Nevertheless, they say their study included over 1.5 million births over an 18-year period and they were able to account for important factors that could have affected the results.
In summary, the authors say their study shows that low Apgar scores within the normal range (seven to 10) “are strongly associated with neonatal mortality and morbidity, and that these associations are substantially stronger with increasing time after birth”.
They add: “Our findings provide strong evidence to support the proposition that the optimal Apgar score is 10 at each time point, and all newborns should be assigned an Apgar score at 10 minutes (with medical intervention if necessary), regardless of their score at one and five minutes.” [...]
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Naroden (left) looks at something shown by Telang Usan assemblyman Dennis Ngau at the State Legislative Assembly today.
KUCHING: Twenty-four projects worth RM39.94 billion have been approved for the Sarawak Corridor of Renewable Energy (SCORE) mega development project since 2008.
Assistant Minister of Entrepreneur and Small and Medium Enterprise (SME) Development Datuk Mohd Naroden Majais said 11 of these approved projects valued at RM19.06 billion are being implemented, creating a total of 10,262 jobs.
“These approved projects are expected to generate a total of 17,828 jobs. We are also having two new investments which have been approved.
“One of the duo is steel project valued at RM17 billion and the other being foaming agent project worth RM500 million,” he said when replying to questions by Jemoreng assemblyman Datuk Dr Juanda Jaya and Tellian assemblyman Yussibnosh Balo in the august House today.
Naroden, who is Assistant Minister of E-Commerce, said SCORE is presently at its Phase II implementation for the period from 2016 to 2020 with focus on cluster development, value-chain industry and research and development (R&D).
He said the Sarawak government is engaging further efforts to promote SCORE among investors from outside Sarawak and Malaysia.
Apart from that, he said the Sarawak government would continue to put in place various infrastructure including telecommunication services and human resource to attract foreign investments.
According to him, SCORE is situated between Jemoreng and Tellian, covering a total area of 70,000 sq km.
Since 2017, Naroden said the coverage of SCORE had been extended to 100,000 sq km to include central and northern region of Sarawak including Limbang and Lawas.
He added that the Mukah division including Jemoreng state constituency had been included in the SCORE development area.
“Jemoreng is strategically located between Mukah and Tanjung Manis which are two important growth nodes of SCORE. Jemoreng can benefit from the development in these areas.”
Naroden told the House that three agencies had been set up under the Regional Corridor Development Authority (RECODA).
They are the Upper Rajang Development Agency (URDA), Highland Development Agency (HDA) and Northern Region Development Agency (NRDA).
These agencies, he said, were established to facilitate and speed up the implementation of various projects within the areas of SCORE.
Towards this end, he pointed out that the Sarawak government had set aside RM1.5 billion each for URDA, HDA and NRDA to provide infrastructure including roads, bridges and electricity and water supply within SCORE areas.
He added that the mega project had successfully attracted ‘trigger industries’ such as aluminium smelter, ferro alloys and polycrystalline silicon.
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