There is evidence concerning the association of low Apgar scores at five minutes with both increased neonatal mortality and increased risk of cerebral palsy.
A retrospective cohort analysis of 151,891 live-born singleton infants without malformations who were delivered at 26 weeks of gestation or later at an inner-city public hospital between January 1988 and December 1998 was undertaken (1)
- paired Apgar scores and umbilical-artery blood pH values were determined for 145,627 infants to assess which test best predicted neonatal death during the first 28 days after birth
- for 13,399 infants born before term (at 26 to 36 weeks of gestation), the neonatal mortality rate was:
- 315 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 5 per 1000 for infants with five-minute Apgar scores of 7 to 10
- for 132,228 infants born at term (37 weeks of gestation or later), the mortality rate was:
- 244 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 0.2 per 1000 for infants with five-minute Apgar scores of 7 to 10
- the risk of neonatal death in term infants with five-minute Apgar scores of 0 to 3 (relative risk, 1460; 95 percent confidence interval, 835 to 2555) was eight times the risk in term infants with umbilical-artery blood pH values of 7.0 or less (180; 95 percent confidence interval, 97 to 334)
Another large population-based cohort study investigated the association between low Apgar score and bothe neonatal death and cerebral palsy (2):
- involved all 235,165 children born between 1983 and 1987 in Norway with a birth weight of at least 2500 g and no registered birth defects were followed up from birth to age 8 to 12 years by linkage of 3 national registries
- outcomes were death and cerebral palsy (CP)
- study results revealed:
- five-minute Apgar scores of 0 to 3 were recorded for 0.1%, and scores of 4 to 6 were recorded for 0.6% of the children
- compared with children who had 5-minute Apgar scores of 7 to 10, children who had scores of 0 to 3 had a 386-fold increased risk for neonatal death (95% CI: 270-552) and an 81-fold (48-138) increased risk for CP
- if Apgar scores at both 1 and 5 minutes were 0 to 3, the risks for neonatal death and CP were increased 642-fold (442-934) and 145-fold (85-248), respectively, compared with scores of 7 to 10
- the study authors concluded that the strong association of low Apgar scores with death and CP in this population with a low occurrence of low scores shows that the Apgar score remains important for the early identification of infants at increased risk for serious and fatal conditions
A systematic review and analysis of a hospital based cohort of Apgar scores of zero at 10 minutes has been undertaken (3):
- 88 infants (94%) either died or were handicapped severely; 2 infants (2%) were handicapped moderately, and 1 infant (1%) was handicapped mildly
- for 3 infants (3%), the long-term outcome could not be determined
- the study authors concluded that the outcome of infants with an Apgar score of zero at 10 minutes is almost universally poor
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