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Background Identifying the risk factors for low APGAR scores at birth is critical for improving neonatal outcomes and guiding clinical interventions. Methods This study aimed to develop a machine-learning model that predicts low APGAR scores by incorporating maternal, fetal, and perinatal factors in Wad Medani, Sudan. Using a Random Forest Classifier, we performed hyper-parameter optimization through Grid Search cross-validation (CV) to identify the best-performing model configuration. Results The optimized model achieved excellent predictive performance, as evidenced by high F1 scores, accuracy, and balanced precision-recall metrics on the test set. In addition to prediction, feature importance analysis was conducted to identify the most influential risk factors contributing to low APGAR scores. Key predictors included gestational age, maternal BMI, mode of delivery, and history of previous complications such as stillbirth or abortion. Using 5-fold cross-validation (CV), the random forest model performance scored accuracy at 96%, precision at 98%, recall at 97%, and F1-score at 97% when classifying infants with APGAR score. Conclusion This study underscores the importance of incorporating machine learning approaches in obstetric care to understand better and mitigate the risk factors associated with adverse neonatal outcomes, particularly low APGAR scores. The results provide a foundation for developing targeted interventions and improving prenatal care practices.

Background The assessment of the newborn after birth is fundamental for identifying those requiring resuscitation. Certain components of the Apgar score are used to assess neonatal condition, but their value is insufficiently validated. We aimed to identify the components of the Apgar score that predict neonatal resuscitation. Methods Individual patient data from two multicenter trials were analyzed. Preterm newborns under 32 weeks of gestation and term newborns with perinatal acidosis and/or resuscitation were included. The extent of resuscitation was quantified by a standardized scoring system, and the clinical condition was quantified by a specified Apgar score. Correlation, linear regression and ROC analyses were used to address the study question. Results A total of 2093 newborns were included. Newborns in poor clinical condition at 1 min received more interventions at 5 and 10 min. Heart rate, muscle tone, reflexes and breathing quality, but not skin color, were moderately strong correlated with the extent of resuscitation at 5 ( r  = 0.44 to 0.52) and 10 min ( r  = 0.38 to 0.42). Heart rate, reflexes and chest movement at 1 min best predicted the subsequent need for resuscitation (R 2  = 0.31). The rare interventions of intubation, chest compressions and epinephrine administration can be predicted by the newborn’s condition at one minute, with a high sensitivity of 84% (cutoff ≤ 4 Apgar points) or a high specificity of 86% (cutoff ≤ 7 Apgar points). Conclusions The clinical impression at 1 min can help to predict the need for medical interventions. Contrary to recent guidelines, heart rate, reflexes and chest movement seem to have the highest values. Trial registration The Test APGAR study was registered at clinicaltrials.gov (NCT00623038, 14/08/2008).

A scoring system is an instrument that enables the scorers, including farmers, technicians, and veterinarians, to adopt a systematic approach for diagnosis or monitoring, as it decreases bias and confounding and increases objectivity. Practically, it is a number assigned to a patient that correlates with a probability that a diagnosis can be confirmed or that a specific outcome will follow. This article examines the clinical scores designed or adapted to bovine medicine that aim to assess newborn calf viability and to diagnose and monitor neonatal calf diarrhea and respiratory diseases, helping the clinician promptly recognize calves needing medical assistance. Despite the large number of clinical scores described in the literature, these are still barely used in farm animal practice; possibly, the complexity of the scores and missing recommendations for intervention are reasons for their lack of popularity as well as the crosswise lack of consistency among scores designed for the same purpose. Further research is needed in this regard to increase scores validation and encourage their application in bovine calf neonatology.

Background Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates. Methods This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes. Results Overall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01–1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06–0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03–3.05) decreased the likelihood of having low Apgar scores at five minutes. Conclusions Timely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5 min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery.

Background Twins are associated with an increased risk of premature birth, a major cause of neonatal morbidity and mortality. Antenatal corticosteroid treatment (ACT) is the main intervention to improve neonatal outcomes in unavoidable preterm births. Our aim was to investigate the association between neonatal outcome and ACT in twin pregnancies with late preterm birth, where the effects of corticosteroids have not been adequately studied. Methods Women with dichorionic-diamniotic twins who had a late preterm birth between 2017 and 2021 at a large referral hospital providing tertiary care and medical training were retrospectively analyzed. Women who met the inclusion criteria were divided into three groups: No ACT ( n  = 209), ACT < 34 weeks’ gestation ( n  = 76) and ACT ≥ 34 weeks’ gestation ( n  = 67). The groups were compared with regard to adverse neonatal complications. Primary outcome measures were composite respiratory and composite neonatal outcomes. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. Results Composite respiratory and composite neonatal outcomes did not differ significantly between groups. Birth gestational age, birthweight and ACT before 34 weeks’ gestation were independently associated with favorable composite respiratory outcome, composite neonatal outcome and a lower neonatal intensive care unit admission rate. Female sex was independently associated with favorable composite respiratory outcome and a lower neonatal intensive care unit admission rate, while birth gestational age and birthweight were independently associated with a lower rate of hypoglycemia. Conclusion ACT at or after 34 weeks’ gestation was not associated with better neonatal outcomes in dichorionic-diamniotic twins born late preterm and was associated with a higher rate of neonatal hypoglycemia than those not treated with corticosteroids.

Neonatal puppies and kittens have physiological and anatomical characteristics that differ from those of adult animals, which impacts the interpretation of physical examination and complementary tests. The veterinarian must be familiar with the clinical, laboratory, and imaging aspects observed in neonates. It is necessary to thoroughly evaluate the litter and the mother to notice the most subtle signs of illness and advise the owner to constantly monitor the newborns, quickly sending them to specialized care. This review describes how to perform clinical assessments of newborns systematically and recognize clinical signs of neonatal changes or affections in puppies and kittens.

Dr. Virginia Apgar was an American anesthesiologist and researcher who heavily influenced the development of neonatal resuscitation in the immediate postpartum period with her simple five-point scoring system. Today, the APGAR scoring system is used around the world in delivery rooms to guide clinicians in the evaluation of newborns and to distinguish which might need urgent resuscitation. With a simple scoring system, timer, and clipboard, Dr. Virginia Apgar shifted focus from the parturient to the neonate, improving infant mortality as a result.

Introduction In this issue of JAMR we celebrate the complexities of the human lung with emphasis on, over eons of time, how we learned about concepts of pulmonary physiology and its impact on pulmonology of the newborn period of life in the 21st century. Working in the famous Pavilion des Debiles at the Maternité in Paris, Pierre Budin collaborated with chief midwife (Madame Henry) and developed a premature infant department dealing with issues of feeding, temperature control and disease management (5). Hospital versus home delivery In the early 20th century there was a movement in the United States to have babies delivered in a hospital setting versus home delivery that resulted in more clinicians (i.e., pediatricians) being involved with newborn care (13). Concern over infant mortality rates and other negative factors in child development led to the development of the U.S. Federal Children's Bureau on April 9, 1912 initially directed by a model of social reform-Julia Lathrop (1858-1932) (14).

Most of today’s readers of this journal will have received an Apgar score 1 and 5 min after birth. The measure was introduced by Virginia Apgar, an anesthesiologist, in 1952; and, since the 1960s, it is popular world-wide. The Apgar score is now ubiquitously used in newborns and arguably the most common composite screening instrument in medicine and only a few single measure screening procedures such as growth curves, glucose levels or blood pressure are more frequently employed.

The third is that she published her work in a paediatric journal, when in fact she published it in the now defunct ‘Current Researches in Anesthesia and Analgesia’ (full text reproduced in the online supplementary appendix).1 SP110.1136/archdischild-2018-315176.supp1 Supplementary file 1 Setting the record straight is one thing, but there are many other remarkable features about Dr Apgar’s life and career which are just as interesting. Persson et al related the Apgar scores at 5 and 10 min in term babies to the subsequent development of epilepsy and cerebral palsy in childhood in a cohort of 1.2 million Swedish children, demonstrating a gradient of rates of neurological morbidity in relation to each increment of the overall score. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.