The Apgar Score and Infant Mortality

Abstract

ObjectiveTo evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period.MethodsThe U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores.ResultsAmong births with a very low Apgar score at five minutes (1–3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births.ConclusionsThe Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.

Predictors of Neonatal Deaths in Ashanti Region of Ghana: A Cross-Sectional Study

“…There was a statistically significant association between a baby's Apgar score and child survival. This corroborates findings from the study by Li et al [26], which found a relationship between five-minute Apgar scores and infant survival. In their study, the Apgar score showed its predictive value for infant death of both very preterm, preterm, and term infants in postneonatal period.…”

Apgar score and the risk of cause-specific infant mortality: a population-based cohort study

“…The net effect of a low Apgar score at 5 minutes on the relative risk of both neonatal and infant mortality is thereby smaller for premature infants than observed at term. Although the Apgar score is associated with mortality at all gestations [5][6][7]20 , the magnitude of the effect changes across the distribution of gestational ages because the background mortality risk of each gestational group varies. Hence, a normal score in preterm infants, unlike full term infants, does not necessarily predict a good outcome 13 .…”

“…Similar associations were reported in a single centre study of 151,891 singletons from 1988-1998 5 . A more recent population study utilising US birth registry data from 1995-2004, also reported increased crude mortality rates among term and pre-term infants with low Apgar scores at 5 minutes 6 . Importantly, however, none of these studies adjusted for known risk factors for mortality including birthweight, social class, smoking status or previous neonatal death.…”

“…Evaluation of the Apgar score at 5 minutes in contemporary populations, where neonatal intensive care provision is routinely available, has been limited 5,6,7 . A population study of 235,165 births from 1983-1987 suggested an association between low Apgar score at 5 minutes and neonatal mortality 7 .…”

The Apgar Score

“…A 5-minute Apgar score of 0 to 3 correlates with neonatal mortality in large populations 11,12 but does not predict individual future neurologic dysfunction. Population studies have uniformly reassured us that most infants with low Apgar scores will not develop cerebral palsy.…”