APGAR scoring

The examination of individual NP case studies by other investigators, as well as summary results of our pilot research, suggest at least two clinically distinct populations. One subsample of PCP abusers has a developmental history of prenatal and birth complications, e.g., prematurity, anoxia at birth, or low APGAR scores, and of early childhood factors, e.g., CHI with loss of consciousness, febrile illnesses with or without convulsions, or chronic ear infections. These histories contribute to developmental learning and performance disorders. In this group, LD causes academic failure and frustrations, which in turn contribute to the development of psychological and interpersonal problems. 

Mirex levels in the blood of pregnant women in Jackson, Mississippi, and the Mississippi Delta area where mirex was extensively used were correlated with the health of the infants they bore. The mean mirex level in maternal blood was 0.54 pg/L (ppb) for 106 samples however, mirex levels in the blood of the infants were not correlated with differences in gestation times, Apgar score, or other problems at birth. Only three children with neurological problems had mothers with pesticide levels, including mirex, above the mean levels (Lloyd et al. 1974). 

Kallen and Robert (2000) found no adverse effects on congenital malformations, childhood cancer, infant mortality, low Apgar score, neonatal jaundice, or neonatal hypothyroidism among infants and children who lived in areas where drinking water was disinfected with chlorine dioxide, compared to controls living in... 

TABLE VI-14 APGAR Scoring for Newborns APGAR (for newborns) ... 

The infant s Apgar scores (scale 0-10, with 10 being best) of 2 at 1 minute and 6 at 5 minutes suggested depression of neurological and cardiopulmonary function. The physicians... 

In a prospective study of 10 pregnant women who were taking lithium before delivery lithium equilibrated completely across the placenta (ratio of umbilical cord lithium concentration to maternal blood = 1.05) across a wide range of maternal lithium serum concentrations (0.2-2.6 mmol/1) infant serum concentrations exceeding 0.64 mmol/1 were associated with lower Apgar scores, longer hospital stays, and higher rates of neuromuscular complications (492). 

SAFETY PROFILE Poison by ingestion, subcutaneous, intraperitoneal, and intravenous routes. Human systemic effects by ingestion general anesthesia and thrombocytopenia (reduction in the number of blood platelets). Human effects on newborn by an unspecified route drug dependency and Apgar score (condition of newborn). Experimental teratogenic and reproductive effects. When heated to decomposition it emits toxic fumes of CL. 

Alfentanil 10 gg/kg in normal parturients does not reduce Apgar scores, but a higher dose (15-30 gg/kg) is recommended for attenuation of the stress response in nonpregnant patients. In a randomized, placebo-controlled. 

Placental transfer occurs and, though there may be some fetal uptake, Apgar scores did not appear to be affected (10,11). 

In 60 women who underwent elective cesarean section under epidural anesthesia, 0.5% levobupivacaine or 0.5% bupivacaine (30 ml) were equally efficacious in terms of anesthesia (115). The incidence and severity of motor blockade, hypotension, changes in QT interval, nausea, and vomiting were not significantly different, and neither were the neonatal Apgar scores. 

The question of possible neurobehavioral effects in the child as a consequence of obstetric analgesia is stiU debated although impairment of visual and neurological performance, reduced alertness, and alterations in walking and muscle tone have aU been reported, most authors have found normal Apgar scores and psychomotor development after obstetric anesthesia (SED-12, 253) (157,158), and any functional defects noted at birth are likely to be transient (159). 

Transplacental transfer of nalbuphine was measured in eight mothers who underwent cesarean section and were given nalbuphine 200 pg/kg intravenously along with thiopental and suxamethonium. The umbilical cord/matemal vein ratio was 1.4 1 at delivery, which occurred at 2-10 minutes after nalbuphine injection. Mean Apgar scores at 1 minute were 6.6 and 8.5 at 5 minutes and did not correlate with either the serum nalbuphine concentration or the time between injection of nalbuphine and delivery (13). 

The relation between maternal morphine administration during labor and the Apgar score of the baby at birth has been studied (SED-11, 137) (96). The authors concluded that morphine alone did not seem to cause asphyxia at birth, but that morphine together with other fetal and/or obstetric factors would definitely be a cause for concern with regard to birth asphyxia. 

The use of alfentanil with bupivacaine via continuous epidural infusion during labor resulted in a significant reduction in motor blockade compared with bupivacaine alone. There was no respiratory depression in the mothers, although shivering and pruritus were more frequent with alfentanil. There were no differences in the neonatal Apgar scores between the groups (SEDA-18, 83). 

A case report involving a 38-year-old female who was in a major depressive episode began taking St. John s wort at 24 gestational weeks and continued with the therapy until delivery. The pregnancy was generally unremarkable, with a relatively mild case of late onset thrombocytopenia and neonatal jaundice that developed at day 5 and responded to treatment. The child was 7 lbs 8 oz, had Apgar scores of 9 at 1 and 5 minutes, normal physical and laboratory results, and normal behavioral assessments at 4 and 33 days (92). 

Cruz AC, Buhi WC, Birk SA, SpeEacy WN. Respiratory distress syndrome with mature lecithin/sphin-gomyelin ratios diabetes mellitus and low Apgar scores. Am J Obstet Gynecol 1978 126 78-82. 

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