The first few minutes of a baby’s life are among the most important.
As such, doctors around the world use Apgar scoring, named after New York doctor Virginia Apgar, to get a quick read on the infant’s health at intervals after birth, starting with one and five minutes.
Apgar scoring runs from 0 to 2 on five separate categories: skin color, pulse rate, irritable reflexes to stimulation, extremity activity and respiratory effort. A score of seven or above is generally considered to be healthy, but a score below that at the five-minute mark has been associated with poor chance of survival and, possibly, poorer health among the survivors.
“If the score is very low at one minute, the baby may not survive,” said Igor Burstyn, PhD, associate professor in the Dornsife School of Public Health.
Burstyn joined a team of researchers from Nigeria and the University of Alberta in Canada to look into what might factor into low early Apgar scores because of their importance in predicting baby health. When looking at the mothers of babies born in hospitals in Ibadan, Nigeria’s third-most-populous city, Burstyn and the researchers considered socio-economic and environmental factors, as well as information related to the birthing process.
“The study helped identify working and living conditions that may put newborns in Nigeria at risk,” Burstyn explained. “Every country has its unique constellation of circumstance and environmental exposure that may reveal associations that do not exist elsewhere.”
Examining conditions to such a specific level is important to making positive change.
“Local epidemiological data tends to help form policy more than data from abroad,” Burstyn said.
Among modifiable environmental risk factors, the study suggested that babies whose mothers reported heavy physical exertion and cooked with kerosene were most likely to have low Apgar scores at one minute after birth, though the association did not hold at the five-minute mark.
The low Apgar scores related to mothers reporting physically demanding work may have been linked to either social inequalities or premature births, both of which could result in poorer baby health.
And kerosene cooking’s relation to low Apgar scores was likely due to the fact that burning this fuel results in inhalable particulate matter, such as hydrocarbons that can be transferred to a growing fetus.
The study looked into occupation specifically and reported associations that might be good targets for future investigation, such as tailoring, catering and hairdressing.
Some factors associated with low Apgar scores at one and five minutes after birth that are uniform with similar studies across the world are factors associated with pregnancy and child birth, such as:
- High blood pressure during pregnancy
- Breech and caesarean births
- Delivery after the due date
- Mother’s water breaking well before labor (called the prolonged rupture of membranes)
Since the study only was able to look at a group of hospitals in the city and many Nigerian births occur at primary care facilities, the patterns of risk observed may not hold for infants born at other facilities.
Understanding these risks is critical because they can be done quickly and lead to interventions sooner. Studies in adults might take longer and, by that time, many more people might be affected.
“For example, if smoking was shown to have adverse effects on the health of infants — a study that can be done in five years — efforts to curb smoking would start long before evidence emerged that adults developed lung cancer at higher rates if they were smokers — a study that took about 50 years,” Burstyn explained.
So studies like these, that try to pinpoint risk so early in life, “can benefit persons of all ages,” Burstyn said.