Newborn assessment and long-term adverse outcome: A systematic review

The medical literature was searched for publications between 1966 and Septe mber 1997 for data on the association of Apgar score, umbilical blood pH, o r Sarnat grading of encephalopathy with long-term adverse outcome. Odds rat ios for these associations were combined to calculate common odds rations w ith 95% confidence intervals. Our search identified abstracts of 1312 studi es and 81 articles with sufficient numeric data to formulate contingency ta bles. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by co mparing umbilical artery pH less than 7 with pH less than or equal to 7 (co mmon odds ration 43; 95% confidence interval 15-124) and by comparing Sarna t grade III with grade II (common odds ratio 24; 95% confidence interval 13 -45). In the prediction of cerebral palsy, the strongest associations were found for Sarnat grade II versus grade II (common odds ratio 20; 95% confid ence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (com mon odds ratio 15; 95% confidence interval 5-50).