Low-normal Apgars are linked to increased adverse neonatal outcomes

  • BMJ

  • International Clinical Digest
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Takeaway

  • Infants with Apgars at the low end of normal (7-10) have increased risk for neonatal mortality and morbidity.
  • Even small declines at 10 vs 5 minutes are associated with adverse outcomes.

Why this matters

  • Author editorial : despite guidelines considering low-normal scores to be reassuring, this evidence suggests otherwise, and assessing Apgars at 10 minutes, as well as 1 and 5 minutes, is important. 

Key results

  • Only 11% of infants had a 10 at 1 minute.
  • As an example of adverse outcomes with minor score differences, aORs for respiratory distress among infants with 9 vs 10 at each timepoint:
    • 1 minute: 2.0 (95% CI, 1.9-2.1);
    • 5 minutes: 5.2 (5.1-5.4); and
    • 10 minutes: 12.4 (12.0-12.9).
  • Vs Apgar of 10 at 10 minutes, aOR for mortality:
    • 4.8 for score of 9.
    • 29.8 for score of 7.
  • Scores below 10 or declining at each timepoint were also associated with asphyxia-related complications, hypoglycemia, and neonatal infections.

Study design

  • Population-based cohort study, Sweden.
  • 1,551,436 term (≥37 weeks) infants without malformations, born 1999-2016.
  • Outcomes: included mortality, infections, asphyxia-related complications, respiratory distress, neonatal hypoglycemia.
  • Funding: Swedish Research Council for Health, Working Life and Welfare.

Limitations

  • Interobserver variability possible.
  • No information about confounding interventions.

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