Apgar index
For each study group, the Apgar index was analyzed in terms of median,
maximum, and minimum. Thus, for all 3 study groups, the following
results were obtained for a 95% confidence interval. Group 1 had a
median Apgar index of 7, with a minimum value of 1 and a maximum value
of 9. Group 2 was characterized by a median of the Apgar index of 8, a
minimum value of 0, and a maximum value of 10. Study group 3 was
characterized by a median Apgar index of 9, a minimum value of 1 and a
maximum value of 10 (Fig 2).
Regarding the mode of birth, for all the 3 study groups, birth through
cesarean section predominated (Table 3). The greatest difference in
percentage was in the group of premature infants with low birth weight
for the gestational age, with a difference of more than 3 times the
percentage (23%) for the spontaneous birth and for the cesarean birth
(77%).
The smallest difference was obtained for the term low birth cases with
low weight for the gestational age, with a difference of 16%, favoring
birth through caesarean section. For the entire study group, birth by
cesarean section predominated, and there was also a statistical
significant difference between the 3 study groups, P = 0.004.
As we have already mentioned in the subchapter dedicated to the working
method, we independently analyzed obstetric and neonatal parameters both
from a descriptive point of view and from the statistical differences
that exist between the 3 study groups.
The incidence of obstetric aspects, namely fetal presentation, obstetric
pathology in the spectrum of hypertensive pregnancy disorders, fetal
malformations, multiple nuchal cord, or true umbilical cord knot is
summarized in Figure 3.
As can be seen, the incidence of pelvic presentation predominates in
pregnancies with low gestational age, that is, in both normal and
low-weight premature pregnancies, and hypertensive pregnancy pathology
has predominated in study groups characterized by low weight; however,
there was no statistical difference for the low birth weight group in
our study.
All the neonatal complications, including the incidence of the
complications within each study group, and the existence or not of
statistical significance for the study groups are shown in the table
below (Table 4).
Analyzing each parameter separately, we obtained a statistically
significant difference, predominantly in preterm infants with low weight
for the gestational age, for the following complications:
cardio-vascular arrest occurred in 6% of the subjects in group 1, with
a significant difference of 1% in the incidence of complications
between groups 2 and 3; for acute respiratory insufficiency, the
difference in incidence was even greater, in which the premature infants
with low weight for the gestational age (24% compared to 8% and 2%
corresponding to the other groups); a difference in the incidence for
ulcer-necrotic enterocolitis (group 1, 13%; group 2, 1%; and group 3,
0%), having statistical significance was otherwise obtained according
to the collected data; hypoxia also predominated among preterm infants:
58% of infants with low weight for gestational age, 23% for premature
infants with weight corresponding to gestational age, and 9% for term
infants with low weight for gestational age.
Respiratory distress had an incidence of 29% in group 1, significantly
higher than group 2 (13%) and group 3 (0%), and cerebral edema
occurred only in premature cases, with an incidence of 6% for those
with low weight for gestational age and 2% for those with appropriate
weight.
Neonatal complications, such as cerebral edema, pulmonary hemorrhage,
neonatal seizures and disseminated intravascular coagulation,
persistence of the arterial canal, cerebral hemorrhage, hyaline membrane
disease, and retinopathy had a 0% incidence in the term neonatal group
with low birth weight. Each of these complications predominated in the
group of preterm newborns with intrauterine growth restriction, with the
exception of the persistence of the arterial canal, which predominated
in study group 2, with an incidence of 1%, and was absent in group 1.
For cerebral edema, pulmonary edema and disseminated intravascular
coagulation, the difference in incidence was statistically significant.
For group 3, complications such as intraventricular hemorrhage and
neonatal anemia presented minimum incidences of 1% and 2%,
respectively. For these complications, the predominance was also the
highest in group 1 (premature infants with low weight for the
gestational age), namely 28% and 32%, respectively, which are
significantly higher percentages than those obtained in the other study
groups.
Regarding the incidence of neonatal infections, a significant incidence
was noted in all 3 study groups, with a significant predominance among
the group of premature infants with low-weight for the gestational age
(38%); meanwhile, for the premature infants with the weight
corresponding to the gestational age, the incidence was 19 %, similar
to that of term newborns with low weight for gestational age (16%).
Regarding neonatal sepsis, a higher incidence was obtained of infants
with low birth weight for gestational age (15%) and significant but
smaller incidence obtained for the other 2 study groups (6% and 8%,
respectively).
Regarding the need for neonatal intensive care, it was 18% for group 1,
5% for group 2, and 1% for group 3, with a statistically significant
difference between the 3 groups. Additionally, a statistically
significant difference was obtained for the rate of neonatal death,
which predominated by 8% in preterm infants with low weight for
gestational age and was absent in term infants with low weight for
gestational age.