Factors associated with low Apgar in newborns in birth center

Santos, Nágela Cristine Pinheiro; Vogt, Sibylle Emilie; Duarte, Elysângela Dittz; Pimenta, Adriano Marçal; Madeira, Lélia Maria; Abreu, Mery Natali Silva

doi:10.1590/0034-7167-2018-0924

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (suppl 3) • 2019 • https://doi.org/10.1590/0034-7167-2018-0924 linkcopy

Factors associated with low Apgar in newborns in birth center

Factores asociados al bajo Apgar en recién nacidos en centro de parto

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to analyze factors associated with Apgar of 5 minutes less than 7 of newborns of women selected for care at the Center for Normal Birth (ANC).

Method: a descriptive cross-sectional study with data from 9,135 newborns collected between July 2001 and December 2012. The analysis used absolute and relative frequency frequencies and bivariate analysis using Pearson’s chi-square test or the exact Fisher.

Results: fifty-three newborns (0.6%) had Apgar less than 7 in the 5th minute. The multivariate analysis found a positive association between low Apgar and gestational age less than 37 weeks, gestational pathologies and intercurrences in labor. The presence of the companion was a protective factor.

Conclusion: the Normal Birth Center is a viable option for newborns of low risk women as long as the protocol for screening low-risk women is followed.

Descriptors: Apgar Score; Natural Childbirth; Obstetric Nursing; Humanizing Delivery; Labor, Obstetric

Variables	Population		Apgar < 7 at the 5th minute
Variables	n	%	n	%	OR	95% CI	p value
Skin color
White	1.984	21.7	8	0.4	1.00 (ref.)	-	-
Brown/Black	4.792	52.5	33	0.7	1.71	0.79 - 3.71	0.173
Yellow/indigenous	86	0.9	0	0.0	*	*	*
No data	2.273	24.9	12	0.5	1.31	0.53 - 3.21	0.554
Educational level
Up to 7 years	2.676	29.3	11	0.4	1.00 (ref.)	-	-
8 to 10 years	2.859	31.3	20	0.7	1.71	0.82 - 3.57	0.155
11 years or more	2.806	30.7	19	0.7	1.65	0.78 - 3.48	0.186
No data	794	8.7	3	0.4	0.92	0.26 - 3.30	0.897
Mother's age (years)
20 to 35	6.612	72.4	36	0.5	1.00 (ref.)	-	-
10 to 14	62	0.7	1	1.6	2.99	0.40 - 22.19	0.283
15 to 19	2.123	23.2	14	0.7	1.22	0.65 - 2.25	0.542
≥ 36	338	3.7	2	0.6	1.09	0.26 - 4.53	0.909

Variables	Population		Apgar < 7 at the 5th minute
Variables	n	%	n	%	OR	95% CI	p value
Parity
Primiparous	3.988	43.7	29	0.7	1.00 (ref.)	-	-
Multiparous	5.138	56.3	24	0.5	0.64	0.37 - 1.10	0.108
Gestational age (weeks)
37 to 40	8.625	94.4	50	0.6	1.00 (ref.)	-	-
< 37	64	0.7	2	3.1	5.53	1.32 - 23.24	0.019
≥ 41	446	4.9	1	0.2	0.39	0.05 - 2.80	0.346
Smoker
No	7.774	84.8	43	0.6	1.00 (ref.)	-	-
Yes	948	10.4	5	0.5	0.95	0.38 - 2.40	0.913
No data	443	4.8	5	1.1	2.04	0.81 - 5.19	0.132
Antecedent pathology
None	8.360	91.5	45	0.5	1.00 (ref.)	-	-
Some	775	8.5	8	1.0	1.93	0.91 - 4.10	0.089
Current pathology
None	7.740	84.7	39	0.5	1.00 (ref.)	-	-
Some	1.395	15.3	14	1.0	2.00	1.08 - 3.70	0.027
Prenatal consultations
≥ 6	6.376	69.8	41	0.6	1.00 (ref.)	-	-
< 6	2.759	30.2	12	0.4	0.67	0.35 - 1.29	0.232

Variables	Population		Apgar < 7 at the 5th minute
Variables	n	%	n	%	OR	95% CI	p value
Meconium liquid
No	7.500	82.1	41	0.6	1.00 (ref.)	-	-
Yes	893	9.8	8	0.9	1.64	0.77 - 3.52	0.200
No data	742	8.1	4	0.5	0.99	0.35 - 2.76	0.979
Oxytocin
No	6.326	69.3	36	0.6	1.00 (ref.)	-	-
Yes	2.809	30.7	17	0.6	1.06	0.60 - 1.90	0.834
Partogram
Yes	7.042	77.1	44	0.6	1.00 (ref.)	-	-
No	2.093	22.9	9	0.4	0.69	0.33 - 1.41	0.306
Companion
Yes	7.204	78.9	32	0.4	1.00 (ref.)	-	-
No	1.931	21.1	21	1.1	2.46	1.42 - 4.28	0.001
Intercurrence in labor
No	8.734	95.6	41	0.5	1.00 (ref.)	-	-
Yes	401	4.4	12	3	6.54	3.41 - 12.54	< 0.001
Analgesia
No	8.563	93.7	47	0.6	1.00 (ref.)	-	-
Yes	572	6.3	6	1.1	1.92	0.82 - 4.51	0.134
Childbirth position
Vertical	3.338	36.5	12	0.4	1.00 (ref.)	-	-
Horizontal	4.787	52.4	34	0.7	1.98	1.03 - 3.83	0.042
Tub	1.010	11.1	7	0.7	1.93	0.76 - 4.92	0.167
Type of delivery
Vaginal	8.917	97.6	47	0.5	1.00 (ref.)	-	-
Forceps	67	0.7	2	3	5.81	1.38 - 24.41	0.016
Cesarean	151	1.7	4	2.7	5.14	1.83 - 14.43	0.002
Prolonged labor
No	8.995	98.5	52	0.6	1.00 (ref.)	-	-
Yes	140	1.5	1	0.7	1.23	0.17 - 9.01	0.834

Variables	OR	95% CI	p value
Gestational age (weeks)
37 to 40	1.00 (ref.)	-	-
< 37	6.12	1.44 - 26.07	0.014
≥ 41	0.36	0.05 - 2.66	0.319
Intercurrence in labor
No	1.00 (ref.)
Yes	5.85	3.02 - 11.33	< 0.001
Presence of companion
Yes	1.00 (ref.)
No	2.24	1.28 - 3.92	0.005
Current pathology
None	1.00 (ref.)
Some	1.87	1.01 - 3.48	0.047

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[TFN1] Note: model fit p-value = 0.71