title: Correlation of Apgar Score with Asphyxial Hepatic Injury and Mortality in Newborns: A Prospective Observational Study From India.
abstract: OBJECTIVE
  The objective of this study is to determine the correlation of Apgar score with asphyxial hepatic injury and neonatal mortality in moderately and severely asphyxiated newborns.
  
  
  METHODS
  This is a secondary analysis of our prospective observational case-controlled study. Sixteen neonates with severe birth asphyxia (five-minute Apgar ≤3) were compared with either 54 moderate asphyxia neonates (five-minute Apgar >3) or 30 normal neonates. Liver function tests were measured on postnatal days 1, 3, and 10 in the study and control groups. Neonatal mortality was observed in the study and control population.
  
  
  RESULTS
  Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for deranged hepatic function showed significant correlation (odds ratio [OR] 4.88, 95% CI 3.26-5.84, P = 0.01 and OR 2.46, 95% CI 1.94-3.32, P = 0.02, respectively). There was a significant increase in serum lactate dehydrogenase (LDH) and total bilirubin on day 1 and serum LDH at age of 10th postnatal life in severely asphyxiated neonates when compared to moderately asphyxiated neonates, whereas there was a significant decrease in total bilirubin and serum albumin on day 3 in severely asphyxiated neonates. There was a significant increase in serum alanine transaminase, serum LDH, and total bilirubin on day 1, serum aspartate transaminase, serum LDH, and total bilirubin on day 3, and International Normalized Ratio on day 10 of postnatal life when severely asphyxiated neonates were compared with normal neonates. There was a significant reduction in total protein and serum albumin on day 1 and direct bilirubin on day 3 in severely asphyxiated neonates when compared with normal neonates. There was a significant increase in neonatal mortality in severely asphyxiated neonates when compared to the other two groups. Correlation of Apgar score in severely asphyxiated neonates compared with normal Apgar score neonates and moderately asphyxiated neonates for neonatal mortality showed significant correlation (odds ratio [OR] 2.23, 95% CI 1.42-3.04, P = 0.03 and OR 1.87, 95% CI 1.64-2.02, P = 0.04, respectively).
  
  
  CONCLUSIONS
  The severity of hepatic dysfunction correlates well with increasing severity of asphyxia. The neonatal mortality also showed good correlation with Apgar score in our study, although we need a large multicentric trial to confirm our observations. Apgar score combined with hepatic dysfunction can be used as a prognostication marker for neonatal mortality.
authors.affiliation: Department of Pediatrics, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Department of Medical and Paediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Choudhary
authors.affiliation: Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India.
authors.forename: Mamta
authors.initials: M
authors.lastname: Lamba
authors.affiliation: Department of Pathology, N.K.P. Salve Medical College, Nagpur, Maharashtra, India.
authors.forename: Sweta
authors.initials: S
authors.lastname: Shastri
keywords: five-minute Apgar score; hepatic dysfunction; moderate birth asphyxia; neonatal mortality; severe birth asphyxia