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

Am J Obstet Gynecol. 1999 Apr;180(4):1024-9. doi: 10.1016/s0002-9378(99)70676-9.


The medical literature was searched for publications between 1966 and September 1997 for data on the association of Apgar score, umbilical blood pH, or Sarnat grading of encephalopathy with long-term adverse outcome. Odds ratios for these associations were combined to calculate common odds ratios with 95% confidence intervals. Our search identified abstracts of 1312 studies and 81 articles with sufficient numeric data to formulate contingency tables. Forty-two of these qualified for inclusion in our meta-analysis. The strongest associations in the prediction of neonatal death were found by comparing umbilical artery pH <7 with pH >/=7 (common odds ratio 43; 95% confidence interval 15-124) and by comparing Sarnat 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 III versus grade II (common odds ratio 20; 95% confidence interval 6-70) and for 20-minute Apgar score 0 to 3 versus 4 to 6 (common odds ratio 15; 95% confidence interval 5-50).

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Apgar Score
  • Cerebral Palsy / epidemiology
  • Fetal Blood / chemistry
  • Follow-Up Studies
  • Humans
  • Hydrogen-Ion Concentration
  • Infant Mortality*
  • Infant, Newborn
  • Odds Ratio
  • Physical Examination*
  • Risk Factors