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2 ARTICLES, IN BMJ , rightly address the risk of apgar score with
cerebral palsy.However in India, when most deleveries are still unattended
by health professionals ,apgar scores are are available only for hospital
births, that also only if delivery is attended by pediarricians. Need for
ippv at birth or delayed cry at birth have been advocated in such
circumstances.Most reports of neonatal outcome with apgar scores are only
from hospital births. In such situations devlpoment of neonatal HIE if the
baby is admitted to a hospital seems more relevant
In level 3 hospital where I am working presntly, it is referal hospital
with level 3 nicu, during a 5 year period 31% were intramural births ,the
rest were extramural births , two third of these had delayed cry at birth,
apgar scores were not known in 50% of extramural births. In such situation
develoment of HIE in nursery is more relvant nearly 17.0% of all babies
devloped HIE .It was noted only in 76% of extramural births with H/O
delayed cry and only in 8% of those with no history of delayed cry at
birth among oUtborn babies, odd ratio for hie with delyed cry was 6.0
Same situation is noted for cerebral palsy at follow up of high risk
neonates , CP in presence of delayed cry was 2.42 (p<.003)
Thus in resouce poor countries, we probably have to rely more on h/o
delaerd cry if apgar scores are not avilable and those babies who seek
admission to health facility, presence of HIE is more relevant for follow
up for cerebral palsy at follow UP
EMAIL... kumari_sudarshan@yahoo.com
Missing apgar scores, where asphyxia is a problem
2 ARTICLES, IN BMJ , rightly address the risk of apgar score with
cerebral palsy.However in India, when most deleveries are still unattended
by health professionals ,apgar scores are are available only for hospital
births, that also only if delivery is attended by pediarricians. Need for
ippv at birth or delayed cry at birth have been advocated in such
circumstances.Most reports of neonatal outcome with apgar scores are only
from hospital births. In such situations devlpoment of neonatal HIE if the
baby is admitted to a hospital seems more relevant
In level 3 hospital where I am working presntly, it is referal hospital
with level 3 nicu, during a 5 year period 31% were intramural births ,the
rest were extramural births , two third of these had delayed cry at birth,
apgar scores were not known in 50% of extramural births. In such situation
develoment of HIE in nursery is more relvant nearly 17.0% of all babies
devloped HIE .It was noted only in 76% of extramural births with H/O
delayed cry and only in 8% of those with no history of delayed cry at
birth among oUtborn babies, odd ratio for hie with delyed cry was 6.0
Same situation is noted for cerebral palsy at follow up of high risk
neonates , CP in presence of delayed cry was 2.42 (p<.003)
Thus in resouce poor countries, we probably have to rely more on h/o
delaerd cry if apgar scores are not avilable and those babies who seek
admission to health facility, presence of HIE is more relevant for follow
up for cerebral palsy at follow UP
EMAIL... kumari_sudarshan@yahoo.com
Competing interests: No competing interests