Apgar values lower than 7 associated with mortality in premature newborns: A retrospective study.

OBJECTIVES: To determine the risk factors associated with mortality in premature newborns (PNB). METHODS: An observational, descriptive, and retrospective study, carried out at the General Hospital of San Juan del Rio, Queretaro, Mexico. The medical records of PNB admitted to the Neonatal Intensive Care Unit from January until December 2018 were studied. RESULTS: A total of 136 PNB were included (74 males and 62 females) of whom 16 (11.7%) died (9 males and 7 females). A correlation was observed between gestational age and birth weight with Apgar values at 1 and 5 minutes (r=0.37, p<0.001). A lower birth weight was found in premature infants with infectious diseases, as well as a lower gestational age in relation to respiratory diseases (p<0.0001). The PNB with Apgar values lower than 7 points at 1 and 5 minutes were more likely to die (p<0.0001). The PNB with very low birth weight (1-1.49 kg), with less than 28 weeks of gestation, and with infectious pathology showed more probabilities of dying (p<0.05). CONCLUSION: Apgar values lower than 7 points in the PNB are associated with the presence of infectious diseases and mortality. Likewise, a lower gestational age represents a lower birth weight, with a higher risk for respiratory and infectious diseases, and consequently an elevated mortality.

Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study.

BACKGROUND: The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation. METHODS: In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. RESULTS: 827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio (P aO2 /F IO2 ) and management with a nonrebreather mask. CONCLUSIONS: Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.