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Per Olofsson - One of the best experts on this subject based on the ideXlab platform.
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gestational age related reference values for Apgar Score and umbilical cord arterial and venous ph in preterm and term newborns
Acta Obstetricia et Gynecologica Scandinavica, 2019Co-Authors: Mehreen Zaigham, Karin Kallen, Per OlofssonAbstract:INTRODUCTION: Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar Scores for term and preterm infants has not yet been determined.MATERIAL AND METHODS: Data were obtained from the maternity units of Skane University Hospital, Malmo and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar Score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean ± standard deviation and median with 2.5th and 97.5th percentiles.RESULTS: Median 5-minute Apgar Score was 7 for gestations shorter than 28 weeks, 8 for 28 weeks, 9 for 29-30 weeks, and 10 from 31 weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P < 0.001).CONCLUSIONS: Median 5-minute Apgar Scores were <10 before 31 weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth. (Less)
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relation between umbilical cord blood ph base deficit lactate 5 minute Apgar Score and development of hypoxic ischemic encephalopathy
Acta Obstetricia et Gynecologica Scandinavica, 2010Co-Authors: Nana Wiberg, Karin Kallen, Andreas Herbst, Per OlofssonAbstract:AbstractObjective. Umbilical cord acid–base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5-minute Apgar Score and hypoxic ischemic encephalopathy (HIE) stage 2–3 was assessed, and new gestational age-adjusted reference standards were compared with traditional stationary reference values. Design and sample. A total of 13,735 pH-validated routine cord acid–base values from singleton deliveries were tested with stationary and gestational age-adjusted reference values using receiver operating characteristic curves and calculation of area under curve. Setting. University hospital. Main outcome measures. Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5-minute Apgar Score < 7 or < 4 or HIE. Results. Gestational age-adjusted values were for all parameters significantly better than crude values to indicate Apgar Score < 7. For Apgar Score < 4, the differences were not...
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base deficit estimation in umbilical cord blood is influenced by gestational age choice of fetal fluid compartment and algorithm for calculation
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Nana Wiberg, Karin Kallen, Per OlofssonAbstract:Objective: The purpose of this study was to explore the influences of gestational age, the choice of fetal fluid compartment, and the algorithm for calculation on the estimation of the base deficit in umbilical cord arterial blood Lit birth. Study design: From 1995 to 2002, cord arterial blood gases and obstetric data were available for 43,551 newborn infants at 37 + weeks of gestation (cohort 1). The mean base deficit in blood and the base deficit in extracellular fluid were estimated from pH and P-CO2 values in 28,213 newborn infants with a 5-minute Apgar Score of >= 9 (cohort 11) with the use of 3 different calculation algorithms (base deficit in blood, base deficit in extracellular fluid [A], and base deficit in extracellular fluid [B]). Results: In cohort 11, the base deficit in blood, the base deficit in extracellular fluid (A), and the base deficit in extracellular fluid (B) increased with advancing gestational age (linear regression, P < .0001). The curves run almost parallel, with the base deficit in blood being higher than the base deficit in extracellular fluid (A) and (B). With the use of receiver operating characteristic Curves in cohort 1, the area under curve to indicate a 5-minute Apgar Score of < 7 and < 4 showed the area under curve-pH to be greater than the area under curve-base deficit in extracellular fluid (A) and (B), the area under curve-base deficit in blood to be greater than the area under Curve-base deficit in extracellular fluid (A) and (B) for a 5-minute Apgar Score of < 7, and the area under curve-base deficit in blood to be greater than the area under curve-base deficit in extracellular fluid (A) and (B) for an Apgar Score of < 4. The cutoffs with highest sensitivity and lowest false-positive rate for a 5-minute Apgar Score of < 7 and < 4 were, for both Scores, a pH value of 7.15, a base deficit in blood of 10 mmol/L, a base deficit in extracellular fluid (A) of 8 mmol/L, and a base deficit in extracellular fluid (B) of 6 mmol/L. Conclusion: The calculated values of the base deficit in umbilical cord arterial blood are influenced decisively by gestational age, the choice of fetal fluid compartment, and the calculation algorithms that are used. The power of the base deficit to indicate neonatal distress depends on the choices of fluid compartment and the algorithm that is used to calculate the base deficit. (c) 2006 Mosby, Inc. All rights reserved.
Atul A Gawande - One of the best experts on this subject based on the ideXlab platform.
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surgical outcome measurement for a global patient population validation of the surgical Apgar Score in 8 countries
Surgery, 2011Co-Authors: Alex B Haynes, Scott E Regenbogen, Thomas G Weiser, Stuart R Lipsitz, Gerald Dziekan, William R Berry, Atul A GawandeAbstract:Background Surgical care is a vital component of health care worldwide, yet there is no clinically meaningful measure of operative outcomes that could be applied globally. The Surgical Apgar Score, a simple metric derived from 3 intraoperative parameters, has been shown in U.S. academic medical centers to predict 30-day patient outcomes after operation, but has not been validated more broadly. Methods We collected the components of the Surgical Apgar Score at the time of operation for 5,909 adult patients undergoing noncardiac operative procedures under general anesthesia at 8 hospitals in diverse international settings and evaluated the relationship between patients’ Scores and the incidence of inpatient postoperative morbidity and mortality, using generalized estimating equations to adjust for clustering within sites. Results During the first 30 days of postoperative hospitalization, 544 patients (9.2%) experienced ≥1 complications. Compared with patients with the median Score of 7—whose complication rate was 9.1%—those with a Surgical Apgar Score n = 302) had an adjusted complication rate of 32.9% (relative risk [RR],3.6; 95% CI, 2.9–4.5), whereas those with a Score of 10 ( n = 238) had a 3.0% adjusted complication rate (RR, 0.3; 95% CI, 0.1–1.1). The Score’s c -statistic for prediction of any complication is 0.70; for death it is 0.77. Conclusion The Surgical Apgar Score is easily calculated, predictive, and moderately discriminative for major complications among adults undergoing inpatient noncardiac operative procedures. Such a Score could provide objective indication of relative postoperative risk for inpatients and provide a potential target for quality improvement efforts, particularly in resource-limited settings.
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the intraoperative surgical Apgar Score predicts postdischarge complications after colon and rectal resection
Surgery, 2010Co-Authors: Scott E Regenbogen, Atul A Gawande, Liliana Bordeianou, Matthew M HutterAbstract:Background We previously developed an intraoperative 10-point Surgical Apgar Score—based on blood loss, lowest heart rate, and lowest mean arterial pressure—to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate whether this intraoperative metric would predict postdischarge complications after colectomy. Methods We linked our institution's National Surgical Quality Improvement Program database with an Anesthesia Intraoperative Management System for all colorectal resections over 4 years. Using Chi-square trend tests and logistic regression, we evaluated the Surgical Apgar Score's prediction for major postoperative complications before and after discharge. Results Among 795 colectomies, there were 230 (29%) major complications within 30 days; 45 (20%) after uncomplicated discharges. Surgical Apgar Scores predicted both inpatient complications and late postdischarge complications (both P Conclusion The intraoperative Surgical Apgar Score remained a useful metric for predicting postcolectomy complications arising after uncomplicated discharges. Even late complications may thus be related to intraoperative condition and events. Surgeons could use this intraoperative metric to target low-scoring patients for intensive postdischarge surveillance and mitigation of postdischarge complications after colectomy.
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does the surgical Apgar Score measure intraoperative performance
Annals of Surgery, 2008Co-Authors: Scott E Regenbogen, Stuart R Lipsitz, Matthew M Hutter, Todd R Lancaster, Caprice C Greenberg, Atul A GawandeAbstract:Objective:To evaluate whether Surgical Apgar Scores measure the relationship between intraoperative care and surgical outcomes.Summary Background Data:With preoperative risk-adjustment now well-developed, the role of intraoperative performance in surgical outcomes may be considered. We previously de
Karin Kallen - One of the best experts on this subject based on the ideXlab platform.
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gestational age related reference values for Apgar Score and umbilical cord arterial and venous ph in preterm and term newborns
Acta Obstetricia et Gynecologica Scandinavica, 2019Co-Authors: Mehreen Zaigham, Karin Kallen, Per OlofssonAbstract:INTRODUCTION: Despite much literature on reference values of acid-base status in umbilical cord blood at birth, there are as yet no studies performed to determine gestational age-dependent references in cord venous blood and no studies on preterm acid-base standards. Similarly, the normal reference range of Apgar Scores for term and preterm infants has not yet been determined.MATERIAL AND METHODS: Data were obtained from the maternity units of Skane University Hospital, Malmo and Lund, Sweden, from 2001 to 2010. Validated paired arterial and venous cord pH values were obtained from 27 175 newborns, of whom 18 584 had spontaneous, non-instrumental vaginal deliveries and a 5-minute Apgar Score equal to or greater than the median value for the individual gestational week. Simple linear and polynomial regression analyses were performed. Values were reported as mean ± standard deviation and median with 2.5th and 97.5th percentiles.RESULTS: Median 5-minute Apgar Score was 7 for gestations shorter than 28 weeks, 8 for 28 weeks, 9 for 29-30 weeks, and 10 from 31 weeks onwards. A linear decline in pH for both cord arterial and venous blood was seen with advancing gestational age (P < 0.001).CONCLUSIONS: Median 5-minute Apgar Scores were <10 before 31 weeks of gestation. Both umbilical cord arterial and venous pH decreased linearly with increasing gestational age. Further studies are needed to show whether gestational age-related pH reference ranges might be preferred to fixed cut-offs in the estimation of umbilical cord acidemia at birth. (Less)
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relation between umbilical cord blood ph base deficit lactate 5 minute Apgar Score and development of hypoxic ischemic encephalopathy
Acta Obstetricia et Gynecologica Scandinavica, 2010Co-Authors: Nana Wiberg, Karin Kallen, Andreas Herbst, Per OlofssonAbstract:AbstractObjective. Umbilical cord acid–base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5-minute Apgar Score and hypoxic ischemic encephalopathy (HIE) stage 2–3 was assessed, and new gestational age-adjusted reference standards were compared with traditional stationary reference values. Design and sample. A total of 13,735 pH-validated routine cord acid–base values from singleton deliveries were tested with stationary and gestational age-adjusted reference values using receiver operating characteristic curves and calculation of area under curve. Setting. University hospital. Main outcome measures. Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5-minute Apgar Score < 7 or < 4 or HIE. Results. Gestational age-adjusted values were for all parameters significantly better than crude values to indicate Apgar Score < 7. For Apgar Score < 4, the differences were not...
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base deficit estimation in umbilical cord blood is influenced by gestational age choice of fetal fluid compartment and algorithm for calculation
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Nana Wiberg, Karin Kallen, Per OlofssonAbstract:Objective: The purpose of this study was to explore the influences of gestational age, the choice of fetal fluid compartment, and the algorithm for calculation on the estimation of the base deficit in umbilical cord arterial blood Lit birth. Study design: From 1995 to 2002, cord arterial blood gases and obstetric data were available for 43,551 newborn infants at 37 + weeks of gestation (cohort 1). The mean base deficit in blood and the base deficit in extracellular fluid were estimated from pH and P-CO2 values in 28,213 newborn infants with a 5-minute Apgar Score of >= 9 (cohort 11) with the use of 3 different calculation algorithms (base deficit in blood, base deficit in extracellular fluid [A], and base deficit in extracellular fluid [B]). Results: In cohort 11, the base deficit in blood, the base deficit in extracellular fluid (A), and the base deficit in extracellular fluid (B) increased with advancing gestational age (linear regression, P < .0001). The curves run almost parallel, with the base deficit in blood being higher than the base deficit in extracellular fluid (A) and (B). With the use of receiver operating characteristic Curves in cohort 1, the area under curve to indicate a 5-minute Apgar Score of < 7 and < 4 showed the area under curve-pH to be greater than the area under curve-base deficit in extracellular fluid (A) and (B), the area under curve-base deficit in blood to be greater than the area under Curve-base deficit in extracellular fluid (A) and (B) for a 5-minute Apgar Score of < 7, and the area under curve-base deficit in blood to be greater than the area under curve-base deficit in extracellular fluid (A) and (B) for an Apgar Score of < 4. The cutoffs with highest sensitivity and lowest false-positive rate for a 5-minute Apgar Score of < 7 and < 4 were, for both Scores, a pH value of 7.15, a base deficit in blood of 10 mmol/L, a base deficit in extracellular fluid (A) of 8 mmol/L, and a base deficit in extracellular fluid (B) of 6 mmol/L. Conclusion: The calculated values of the base deficit in umbilical cord arterial blood are influenced decisively by gestational age, the choice of fetal fluid compartment, and the calculation algorithms that are used. The power of the base deficit to indicate neonatal distress depends on the choices of fluid compartment and the algorithm that is used to calculate the base deficit. (c) 2006 Mosby, Inc. All rights reserved.
Nana Wiberg - One of the best experts on this subject based on the ideXlab platform.
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relation between umbilical cord blood ph base deficit lactate 5 minute Apgar Score and development of hypoxic ischemic encephalopathy
Acta Obstetricia et Gynecologica Scandinavica, 2010Co-Authors: Nana Wiberg, Karin Kallen, Andreas Herbst, Per OlofssonAbstract:AbstractObjective. Umbilical cord acid–base analysis is fundamental for assessing intrapartum hypoxia. The accuracy of arterial umbilical cord blood lactate, pH and base deficit to reflect a low 5-minute Apgar Score and hypoxic ischemic encephalopathy (HIE) stage 2–3 was assessed, and new gestational age-adjusted reference standards were compared with traditional stationary reference values. Design and sample. A total of 13,735 pH-validated routine cord acid–base values from singleton deliveries were tested with stationary and gestational age-adjusted reference values using receiver operating characteristic curves and calculation of area under curve. Setting. University hospital. Main outcome measures. Accuracy of low pH, high base deficit and high lactate, alone or in combination, to imply 5-minute Apgar Score < 7 or < 4 or HIE. Results. Gestational age-adjusted values were for all parameters significantly better than crude values to indicate Apgar Score < 7. For Apgar Score < 4, the differences were not...
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base deficit estimation in umbilical cord blood is influenced by gestational age choice of fetal fluid compartment and algorithm for calculation
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Nana Wiberg, Karin Kallen, Per OlofssonAbstract:Objective: The purpose of this study was to explore the influences of gestational age, the choice of fetal fluid compartment, and the algorithm for calculation on the estimation of the base deficit in umbilical cord arterial blood Lit birth. Study design: From 1995 to 2002, cord arterial blood gases and obstetric data were available for 43,551 newborn infants at 37 + weeks of gestation (cohort 1). The mean base deficit in blood and the base deficit in extracellular fluid were estimated from pH and P-CO2 values in 28,213 newborn infants with a 5-minute Apgar Score of >= 9 (cohort 11) with the use of 3 different calculation algorithms (base deficit in blood, base deficit in extracellular fluid [A], and base deficit in extracellular fluid [B]). Results: In cohort 11, the base deficit in blood, the base deficit in extracellular fluid (A), and the base deficit in extracellular fluid (B) increased with advancing gestational age (linear regression, P < .0001). The curves run almost parallel, with the base deficit in blood being higher than the base deficit in extracellular fluid (A) and (B). With the use of receiver operating characteristic Curves in cohort 1, the area under curve to indicate a 5-minute Apgar Score of < 7 and < 4 showed the area under curve-pH to be greater than the area under curve-base deficit in extracellular fluid (A) and (B), the area under curve-base deficit in blood to be greater than the area under Curve-base deficit in extracellular fluid (A) and (B) for a 5-minute Apgar Score of < 7, and the area under curve-base deficit in blood to be greater than the area under curve-base deficit in extracellular fluid (A) and (B) for an Apgar Score of < 4. The cutoffs with highest sensitivity and lowest false-positive rate for a 5-minute Apgar Score of < 7 and < 4 were, for both Scores, a pH value of 7.15, a base deficit in blood of 10 mmol/L, a base deficit in extracellular fluid (A) of 8 mmol/L, and a base deficit in extracellular fluid (B) of 6 mmol/L. Conclusion: The calculated values of the base deficit in umbilical cord arterial blood are influenced decisively by gestational age, the choice of fetal fluid compartment, and the calculation algorithms that are used. The power of the base deficit to indicate neonatal distress depends on the choices of fluid compartment and the algorithm that is used to calculate the base deficit. (c) 2006 Mosby, Inc. All rights reserved.
Scott E Regenbogen - One of the best experts on this subject based on the ideXlab platform.
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surgical outcome measurement for a global patient population validation of the surgical Apgar Score in 8 countries
Surgery, 2011Co-Authors: Alex B Haynes, Scott E Regenbogen, Thomas G Weiser, Stuart R Lipsitz, Gerald Dziekan, William R Berry, Atul A GawandeAbstract:Background Surgical care is a vital component of health care worldwide, yet there is no clinically meaningful measure of operative outcomes that could be applied globally. The Surgical Apgar Score, a simple metric derived from 3 intraoperative parameters, has been shown in U.S. academic medical centers to predict 30-day patient outcomes after operation, but has not been validated more broadly. Methods We collected the components of the Surgical Apgar Score at the time of operation for 5,909 adult patients undergoing noncardiac operative procedures under general anesthesia at 8 hospitals in diverse international settings and evaluated the relationship between patients’ Scores and the incidence of inpatient postoperative morbidity and mortality, using generalized estimating equations to adjust for clustering within sites. Results During the first 30 days of postoperative hospitalization, 544 patients (9.2%) experienced ≥1 complications. Compared with patients with the median Score of 7—whose complication rate was 9.1%—those with a Surgical Apgar Score n = 302) had an adjusted complication rate of 32.9% (relative risk [RR],3.6; 95% CI, 2.9–4.5), whereas those with a Score of 10 ( n = 238) had a 3.0% adjusted complication rate (RR, 0.3; 95% CI, 0.1–1.1). The Score’s c -statistic for prediction of any complication is 0.70; for death it is 0.77. Conclusion The Surgical Apgar Score is easily calculated, predictive, and moderately discriminative for major complications among adults undergoing inpatient noncardiac operative procedures. Such a Score could provide objective indication of relative postoperative risk for inpatients and provide a potential target for quality improvement efforts, particularly in resource-limited settings.
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the intraoperative surgical Apgar Score predicts postdischarge complications after colon and rectal resection
Surgery, 2010Co-Authors: Scott E Regenbogen, Atul A Gawande, Liliana Bordeianou, Matthew M HutterAbstract:Background We previously developed an intraoperative 10-point Surgical Apgar Score—based on blood loss, lowest heart rate, and lowest mean arterial pressure—to predict major complications after colorectal resection. However, because complications often arise after uncomplicated hospitalizations, we sought to evaluate whether this intraoperative metric would predict postdischarge complications after colectomy. Methods We linked our institution's National Surgical Quality Improvement Program database with an Anesthesia Intraoperative Management System for all colorectal resections over 4 years. Using Chi-square trend tests and logistic regression, we evaluated the Surgical Apgar Score's prediction for major postoperative complications before and after discharge. Results Among 795 colectomies, there were 230 (29%) major complications within 30 days; 45 (20%) after uncomplicated discharges. Surgical Apgar Scores predicted both inpatient complications and late postdischarge complications (both P Conclusion The intraoperative Surgical Apgar Score remained a useful metric for predicting postcolectomy complications arising after uncomplicated discharges. Even late complications may thus be related to intraoperative condition and events. Surgeons could use this intraoperative metric to target low-scoring patients for intensive postdischarge surveillance and mitigation of postdischarge complications after colectomy.
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does the surgical Apgar Score measure intraoperative performance
Annals of Surgery, 2008Co-Authors: Scott E Regenbogen, Stuart R Lipsitz, Matthew M Hutter, Todd R Lancaster, Caprice C Greenberg, Atul A GawandeAbstract:Objective:To evaluate whether Surgical Apgar Scores measure the relationship between intraoperative care and surgical outcomes.Summary Background Data:With preoperative risk-adjustment now well-developed, the role of intraoperative performance in surgical outcomes may be considered. We previously de