Flow chart of subjects included.

<p>Flow chart of subjects included.</p

Neonatal (A) and post-neonatal mortality (B) by five-minute Apgar score and gestational age.

<p>Neonatal (A) and post-neonatal mortality (B) by five-minute Apgar score and gestational age.</p

The Apgar Score and Infant Mortality

<div><p>Objective</p><p>To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period.</p><p>Methods</p><p>The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores.</p><p>Results</p><p>Among births with a very low Apgar score at five minutes (1–3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births.</p><p>Conclusions</p><p>The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.</p></div

Distribution of Apgar score at 5 minutes in preterm, term & post-term births and corresponding neonatal & post-neonatal mortality rates.

<p>Distribution of Apgar score at 5 minutes in preterm, term & post-term births and corresponding neonatal & post-neonatal mortality rates.</p

Effect of maternal diet on dam, baby and adult offspring.

<p>(A) Mean body weights of dam fed with the control diet (Ctrl), high fatty (HF) or highly palatable diet (HP) (n = 10 in each group). Dam were weighted 6 weeks before mating, at the time of mating and after the delivery of their offspring. (B–C) Mean body weight of offspring born to dams fed with the Ctrl diet (n = 9), HF diet (n = 10), and HP diet (n = 11), measured at birth (day 1), and in adulthood (10 weeks after birth). (D–F) Physiological parameters of offspring born to dams fed with the Ctrl diet (n = 9), HF diet (n = 10), and HP diet (n = 11). *p<0.05; **p<0.001.</p

Survival curves in preterm (A) and term (B) births for White and Black infants by five-minute Apgar score from birth to 1 year.

<p>Survival curves in preterm (A) and term (B) births for White and Black infants by five-minute Apgar score from birth to 1 year.</p

Mortality rates for singleton births and twins by five-minute Apgar score at gestational age of 24–36 weeks (A–C) and 37–41 weeks (D–F).

<p>(A and D: Time of Infant Death≤1 Day, B and E: Time of Infant Death between 2 and 27 Days, C and F: Time of Infant Death≥28 Days).</p

Phosphorylation of STAT-3 in the hypothalamus.

<p>(A) Representative images for western blot experiement on total (t-) and phosphorylated (p-) STAT-3. n = 9 for Ctrl group, n = 10 for HF group, and n = 11 for HP group, respectively. (B) Measurement of the p-STAT-3/total-STAT-3 ratio in saline injected rats and in leptin injected rats. For clearly comparison, all the p-STAT-3/t-STAT-3 ratios were normalized to the mean value that obtained from the Ctrl group. (C) The sensitivity toward leptin assessed by a significant elevation of the mean p-STAT-3/t-STAT-3 in leptin-injected compared to saline-injected rats. **p<0.001, compared as indicated.</p

Maternal characteristics of the study population.

<p>Maternal characteristics of the study population.</p

Mortality rates for White, Black and Hispanic infants by five-minute Apgar score at gestational age of 24–36 weeks (A–C) and 37–41 weeks (D–F).

<p>(A and D: Time of Infant Death≤1 Day, B and E: Time of Infant Death between 2 and 27 Days, C and F: Time of Infant Death≥28 Days).</p