Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1798-e1804 (doi:10.1542/peds.2006-0102)

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ARTICLE

Earlier Apgar Score Increase in Severely Depressed Term Infants Cared for in Swedish Level III Units With 40% Oxygen Versus 100% Oxygen Resuscitation Strategies: A Population-Based Register Study

Lena Hellström-Westas, MD, PhD^a, Kristina Forsblad, MD^b, Gunnar Sjörs, MD, PhD^c, Ola Didrik Saugstad, MD, PhD^d, Lars J. Björklund, MD, PhD^a, Karel Marál, MD, PhD^e and Karin Källén, PhD^f

^a Departments of Pediatrics
^e Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden
^b Department of Pediatrics, Helsingborg Hospital, Helsingborg, Sweden
^c Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden
^d Department of Pediatric Research, Faculty Division of Medicine, Rikshospitalet Medical Center, University of Oslo, Oslo, Norway
^f Perinatal Epidemiology Research Center, Tornblad Institute, Lund University, Lund, Sweden

OBJECTIVES. The aim of this study was to evaluate whether a resuscitation strategy based on administration of 40% oxygen influences mortality rates and rates of improvement in 5-minute Apgar scores, compared with a strategy based on 100% oxygen administration.

METHODS. A population-based study evaluated data from 4 Swedish perinatal level III centers during the period of 1998 to 2003. During this period, the centers used either of 2 resuscitation strategies (initial oxygen administration of 40% or 100%). Live-born, singleton, term infants with 1-minute Apgar scores of <4, with a birth weight appropriate for gestational age, and without major malformations were included in the study (n = 1223).

RESULTS. Infants born in hospitals using a 40% oxygen strategy had a more rapid Apgar score increase than did infants born in hospitals using a 100% oxygen strategy; however, no difference remained at 10 minutes. The mean Apgar score increased from 2.01 at 1 minute to 6.74 at 5 minutes in the 2 hospitals initiating resuscitation with 40% oxygen, compared with 2.01 to 6.38 in the 2 hospitals using 100% oxygen, with a mean difference in Apgar score increases of 0.36. At 5 minutes, 44.3% of infants born in the hospitals using 100% oxygen had an Apgar score of <7, compared with 34.0% of infants at the hospitals using 40% oxygen. At 10 minutes, the mean Apgar scores were 8.16 at the hospitals using 40% oxygen and 8.07 at the hospitals using 100% oxygen. There were no significant differences in rates of neonatal death, hypoxic ischemic encephalopathy, or seizures in relation to the 2 oxygen strategies.

CONCLUSION. Severely depressed term infants born in hospitals initiating resuscitation with 40% oxygen had earlier Apgar score recovery than did infants born in hospitals using a 100% oxygen strategy.

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Key Words: Apgar score • term • newborn • oxygen • resuscitation

Abbreviations: MBR—Medical Birth Register • CI—confidence interval • OR—odds ratio

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Accepted Jul 17, 2006.

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