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A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya

BACKGROUND: Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings. OBJECTIVE: This study determin...

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Autores principales: Njie, Albertine Enjema, Nyandiko, Winstone Mokaya, Ahoya, Phinehas Ademi, Moutchia, Jude Suh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10208496/
https://www.ncbi.nlm.nih.gov/pubmed/37224111
http://dx.doi.org/10.1371/journal.pone.0285828
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author Njie, Albertine Enjema
Nyandiko, Winstone Mokaya
Ahoya, Phinehas Ademi
Moutchia, Jude Suh
author_facet Njie, Albertine Enjema
Nyandiko, Winstone Mokaya
Ahoya, Phinehas Ademi
Moutchia, Jude Suh
author_sort Njie, Albertine Enjema
collection PubMed
description BACKGROUND: Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings. OBJECTIVE: This study determined how effectively the APGAR score is used to diagnose birth asphyxia in comparison to the gold standard (umbilical cord blood pH <7 with neurologic involvement) at Moi Teaching and Referral Hospital (MTRH), and identified healthcare provider factors that affect ineffective use of the score. METHODS: Using a quantitative cross-sectional hospital-based design, term babies born in MTRH who weighed ≥2500g were randomly and systematically sampled; and healthcare providers who assign APGAR scores were enrolled via a census. Umbilical cord blood was drawn at birth and at 5minutes for pH analysis. APGAR scores assigned by healthcare providers were recorded. Effective use of the APGAR score was determined by sensitivity, specificity, positive and negative predictive values. At a significance level of 0.05, multiple logistic regression analysis identified the independent provider-associated factors affecting ineffective use of the APGAR score. RESULTS: We enrolled 102 babies, and 50 (49%) were females. Among the 64 healthcare providers recruited, 40 (63%) were female and the median age was 34.5years [IQR: 31.0, 37.0]. Assigned APGAR scores had a sensitivity of 71% and specificity of 89%, with positive and negative predictive values of 62% and 92% respectively. Healthcare provider factors associated with ineffective APGAR score use included: instrumental delivery (OR: 8.83 [95% CI: 0.79, 199]), lack of access to APGAR scoring charts (OR: 56.0 [95% CI: 12.9, 322.3]), and neonatal resuscitation (OR: 23.83 [95% CI: 6.72, 101.99]). CONCLUSION: Assigned APGAR scores had low sensitivity and positive predictive values. Healthcare provider factors independently associated with ineffective APGAR scoring include; instrumental delivery, lack of access to APGAR scoring charts, and neonatal resuscitation.
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spelling pubmed-102084962023-05-25 A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya Njie, Albertine Enjema Nyandiko, Winstone Mokaya Ahoya, Phinehas Ademi Moutchia, Jude Suh PLoS One Research Article BACKGROUND: Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings. OBJECTIVE: This study determined how effectively the APGAR score is used to diagnose birth asphyxia in comparison to the gold standard (umbilical cord blood pH <7 with neurologic involvement) at Moi Teaching and Referral Hospital (MTRH), and identified healthcare provider factors that affect ineffective use of the score. METHODS: Using a quantitative cross-sectional hospital-based design, term babies born in MTRH who weighed ≥2500g were randomly and systematically sampled; and healthcare providers who assign APGAR scores were enrolled via a census. Umbilical cord blood was drawn at birth and at 5minutes for pH analysis. APGAR scores assigned by healthcare providers were recorded. Effective use of the APGAR score was determined by sensitivity, specificity, positive and negative predictive values. At a significance level of 0.05, multiple logistic regression analysis identified the independent provider-associated factors affecting ineffective use of the APGAR score. RESULTS: We enrolled 102 babies, and 50 (49%) were females. Among the 64 healthcare providers recruited, 40 (63%) were female and the median age was 34.5years [IQR: 31.0, 37.0]. Assigned APGAR scores had a sensitivity of 71% and specificity of 89%, with positive and negative predictive values of 62% and 92% respectively. Healthcare provider factors associated with ineffective APGAR score use included: instrumental delivery (OR: 8.83 [95% CI: 0.79, 199]), lack of access to APGAR scoring charts (OR: 56.0 [95% CI: 12.9, 322.3]), and neonatal resuscitation (OR: 23.83 [95% CI: 6.72, 101.99]). CONCLUSION: Assigned APGAR scores had low sensitivity and positive predictive values. Healthcare provider factors independently associated with ineffective APGAR scoring include; instrumental delivery, lack of access to APGAR scoring charts, and neonatal resuscitation. Public Library of Science 2023-05-24 /pmc/articles/PMC10208496/ /pubmed/37224111 http://dx.doi.org/10.1371/journal.pone.0285828 Text en © 2023 Njie et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Njie, Albertine Enjema
Nyandiko, Winstone Mokaya
Ahoya, Phinehas Ademi
Moutchia, Jude Suh
A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title_full A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title_fullStr A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title_full_unstemmed A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title_short A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya
title_sort comparative analysis of apgar score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10208496/
https://www.ncbi.nlm.nih.gov/pubmed/37224111
http://dx.doi.org/10.1371/journal.pone.0285828
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