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Suggest treatment for low Apgar scores and respiratory distress in infants

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Posted on Wed, 13 May 2015
Question: infant was diagnosed with with low papp-a in first trimester, born in 2012 with low apgars; respiratory distress and apena. which continues to present. Question: Should there have been follow up testing after initial finding of Low PAPP-A to anticipate these issues Thank you.
doctor
Answered by Dr. Aarti Abraham (45 minutes later)
Brief Answer:
As below.

Detailed Answer:
Hello
Thanks for writing to us with your health concern.
I am Dr. Abraham, OB - GYN, and would be glad to assist you with your concern.
Low PAPPA - A is generally a screening test done to screen babies at high risk of Down's syndrome.
A positive screen ( low PAPP - A ) prompts further evaluation for Down's syndrome.
Recently, there is evidence to show that a low PAPPA level is associated with other adverse perinatal outcomes such as -
small size for gestational age (SGA), preterm labour, hypertensive disorders of pregnancy, spontaneous abortion, and stillbirth.
Most of these conditions would result in a baby born with low Apgar scores and respiratory distress.
Yes, a low PAPPA level should alert the obstetrician regarding a higher risk for development of such factors.
Follow up testing is recommended in such a case, particularly if the mother has any ominous features in history, physical exam or family history.
I would be most happy to elucidate further if you could elaborate on what you specifically wish to discuss here.
Hope my answer helped you.
All the best
Please feel free to discuss further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (17 hours later)
Dear Doctor Abraham: Thank you for your prompt, clear and informative response.. Your time and effort was greatly appreciated. If feasible or consistent with healthcare magic policy, could you advise me of any medical research that appears to indicate low PAPP-A is/or can can be a causable factor in respiratpry distress ; low APGAR scores and Central Apnea at birth. Here infant was pre maturely induced (no medical reason) at 37 wks. Thank you once again AJB
doctor
Answered by Dr. Aarti Abraham (16 hours later)
Brief Answer:
Please go through the links.

Detailed Answer:
Hello
Sorry for a delay in the response, was somehow unable to access the internet !
I have read your follow up, and first of all, thank you for your appreciative, kind words.
You help us to keep doing our work !
Now for your question.
IT is quite consistent with the website policy for me to provide you with relevant studies or medical literature that you might ask for.
In this case, we are looking for studies that indicate that a low PAPP- A in the first trimester can lead to respiratory distress, low Apgar scores and apnea at birth.
I am providing a few links, kindly peruse them, and let me know if I can help in any further manner.
Here are the links -
http://onlinelibrary.wiley.com/doi/10.1002/uog.8050/pdf
https://fetalmedicine.org/abstracts/2014/abstracts/522.pdf ( Read the conclusion particularly in this article - it pertinently answers your index query )
http://www.theovalplanet.com/post.cfm/poor-outcomes-in-patients-with-low-papp-a-during-testing-for-down-syndrome
http://www.researchgate.net/publication/0000_Low_pregnancy_associated_plasma_protein-a_%28PAPP-A%29_in_the_first_trimester__is_it_a_predictor_of_poor_perinatal_outcome

I have posted 4 studies.
I hope that should suffice.
Take care, and looking forward to hearing from you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Aarti Abraham

OBGYN

Practicing since :1998

Answered : 6010 Questions

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Suggest treatment for low Apgar scores and respiratory distress in infants

Brief Answer: As below. Detailed Answer: Hello Thanks for writing to us with your health concern. I am Dr. Abraham, OB - GYN, and would be glad to assist you with your concern. Low PAPPA - A is generally a screening test done to screen babies at high risk of Down's syndrome. A positive screen ( low PAPP - A ) prompts further evaluation for Down's syndrome. Recently, there is evidence to show that a low PAPPA level is associated with other adverse perinatal outcomes such as - small size for gestational age (SGA), preterm labour, hypertensive disorders of pregnancy, spontaneous abortion, and stillbirth. Most of these conditions would result in a baby born with low Apgar scores and respiratory distress. Yes, a low PAPPA level should alert the obstetrician regarding a higher risk for development of such factors. Follow up testing is recommended in such a case, particularly if the mother has any ominous features in history, physical exam or family history. I would be most happy to elucidate further if you could elaborate on what you specifically wish to discuss here. Hope my answer helped you. All the best Please feel free to discuss further.