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