Comparison of the Combined versus Conventional Apgar Scores in Predicting Adverse Neonatal Outcomes

Objectives

Assessing the value of the Combined-Apgar score in predicting neonatal mortality and morbidity compared to the Conventional-Apgar.

Methods

This prospective cohort study evaluated 942 neonates (166 very preterm, 233 near term, and 543 term) admitted to a tertiary referral hospital. At 1- and 5-minutes after delivery, the Conventional and Combined Apgar scores were recorded. The neonates were followed, and the following information was recorded: the occurrence of severe hyperbilirubinemia requiring medical intervention, the requirement for mechanical ventilation, the occurrence of intraventricular hemorrhage (IVH), and neonatal mortality.

Results

Before adjusting for the potential confounders, a low Conventional (<7) or Combined (<10) Apgar score at 5-minutes was associated with adverse neonatal outcomes. However, after adjustment for the gestational age, birth weight and the requirement for neonatal resuscitation in the delivery room, a depressed 5-minute Conventional-Apgar score lost its significant associations with all the measured adverse outcomes; after the adjustments, a low 5-minute Combined-Apgar score remained significantly associated with the requirement for mechanical ventilation (OR,18.61; 95%CI,6.75–51.29), IVH (OR,4.8; 95%CI,1.91–12.01), and neonatal mortality (OR,20.22; 95%CI,4.22–96.88). Additionally, using Receiver Operating Characteristics (ROC) curves, the area under the curve was higher for the Combined-Apgar than the Conventional-Apgar for the prediction of neonatal mortality and the measured morbidities among all the admitted neonates and their gestational age subgroups.

Conclusions

The newly proposed Combined-Apgar score can be a good predictor of neonatal mortality and morbidity in the admitted neonates, regardless of their gestational age and resuscitation status. It is also superior to the Conventional-Apgar in predicting adverse neonatal outcomes in very preterm, near term and term neonates.     

Non-selective cation channels in basolateral-membrane vesicles from pars recta of rabbit kidney proximal tubule.

The characteristics of 86Rb+ fluxes through conductive channels in basolateral-membrane vesicles isolated from pars recta of rabbit kidney proximal tubule were investigated. In RbCl-, KCl- and NaCl-loaded vesicles a transient and almost equal accumulation of 86Rb+ was observed. The uptakes of 86Rb+ were inhibited to the same extent by 10 mM-BaCl2 in all loadings. The accumulation was driven by an electrical diffusion potential. The 86Rb+ flux was dependent on intravesicular Ca2+. Increasing concentrations of Ca2+ gradually decreased the 86Rb+ uptake. At 10 microM-Ca2+ the radioisotope flux was below 20% of control. The vesicles containing the channel showed very low selectivity among the univalent cations K+, Rb+, Li+, Na+ and choline+.     

Some studies on field distribution and seed germination ofSuaeda fruticosa andSporobolus arabicus with reference to salinity and sodicity of the medium

Summary Vegetation of two wasteland sites near Dera Chahl, 30 km from Lahore, was studied quantitatively. Soil samples obtained from the two sites were analysed.Suaeda fruticosa (L.) Forssk. was a dominant species on saline and sodic soil whereas soil underSporobolus arabicus Boiss. was saline and non-sodic. Seed germination studies show thatSporobolus arabicus is relatively more affected by Nasalinity than by Ca-salinity. This species tolerates salinity to some extent but is sensitive to sodicity.Suaeda fruticosa is relatively more tolerant to salinity and sodicity thanSporobolus arabicus and is capable of growing on saline and sodic soils.     

Effect of restricted watering and its combination with root pruning on root growth capacity,water status and food reserves ofPinus caribaea var.hondurensis seedlings

Summary Six-month oldPinus caribaea var.hondurensis seedling were subjected to various regimes of restricted watering and their combinations with root pruning to determine a suitable technique of producing seedlings with optimum physiological condition for successful bare-root planting.From the range of treatments tested, plants subjected to watering once every 9 days (D9) were found to be the hardest in terms of highest root growth capacity, leaf water content, root starch content and in having a moderately low transpiration rate.P. caribaea seedlings subjected to this preconditioning treatment may be more able to survive bare-root planting.     

A study of steric and electronic factors governing the position of biofunctionalization of the benz(a)anthracene nucleus: Metabolism in vitro of fluoro- and methyl-substituted analogs

Metabolism of selected fluoro and methyl analogs of benz(a)anthracene were studied in induced and uninduced rat liver S-10 fractions. Examination of the various metabolites produced from these substrates led to the conclusion that both steric and electronic factors determine the preferential sites of bioactivation. A hypothesis is proposed to explain the results.     

Simultaneous immunohistochemical detection of IUdR and BrdU infused intravenously to cancer patients

Cell cycle kinetics of solid tumors in the past have been restricted to an in vitro labeling index (LI) measurement. Two thymidine analogues, bromodeoxyuridine (BrdU) and iododeoxyuridine (IUdR), can be used to label S-phase cells in vivo because they can be detected in situ by use of monoclonal antibodies (MAb) against BrdU (Br-3) or IUdR (3D9). Patients with a variety of solid tumors (lymphoma, brain, colon cancers) received sequential intravenous IUdR and BrdU. Tumor tissue removed at the end of infusion was embedded in plastic and treated with MAb Br-3 and 3D9 sequentially, using a modification of a previously described method. Clearly single and double labeled cells were visible, which enabled us to determine the duration of S-phase (Ts) and the total cell cycle time (Tc), in addition to the LI in these tumors. Detailed control experiments using tissue culture cell lines as well as bone marrow cells from leukemic patients are described, including the comparison of this double label technique with our previously described BrdU-tritiated thymidine technique. We conclude that the two methods are comparable and that the IUdR/BrdU method permits rapid and reliable cell cycle measurements in solid tumors.     

Characteristics of D-alanine transport by luminal membrane vesicles from pars convoluta and pars recta of rabbit proximal tubule

Uptake of D-alanine against a concentration gradient has been shown to occur with isolated luminal-membrane vesicles from pars convoluta or pars recta of rabbit proximal tubule. Renal D-alanine transport systems, displaying the following characteristics, were shown: (1) In vesicles from pars convoluta, the uptake of D-alanine was mediated by both Na+-dependent and Na+-independent transport processes. It was found that an inwardly directed H+-gradient could drive the transport of D-alanine into the vesicles both in the presence and absence of Na+. Thus, in addition to Na+, the transport of D-alanine is influenced by the H+-gradient. (2) In vesicles from pars recta, the transient accumulation of D-alanine was strictly dependent on Na+, since no 'overshoot' was ever observed in the absence of Na+. Although the Na+-dependent uptake of D-alanine was stimulated at acid pH, H+ did not substitute for Na+, as it apparently does in pars convoluta, but instead potentiated the Na+ effect. (3) Addition of L-alanine to vesicle preparations, both from pars convoluta and from pars recta, specifically inhibited renal uptake of D-alanine. A comparison between the transport characteristics of D- and L-alanine indicated that these two isomers of alanine probably share common transport systems located along the proximal tubule of rabbit kidney.