Validity of Apgar Score as an Indicator of Neonatal SARS-CoV-2 Infection: A Scoping Review

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts on healthcare systems worldwide, particularly regarding the care of pregnant women and their neonates. The use of the Apgar score—a discrete numerical index used to evaluate neonatal condition immediately following delivery that has been used ubiquitously as a clinical indicator of neonatal condition and widely reported in the literature for decades—has continued during the pandemic. Although health systems adopted protocols that addressed pregnant women and their neonates during the pandemic, limited research has assessed the validity of Apgar scores for determining neonatal conditions in the context of COVID-19. Therefore, this scoping review was conducted on the first 2 years of the pandemic and included mothers with reverse transcription-polymerase chain reaction confirmed COVID-19 and their resulting positive or negative neonates. In total, 1,966 articles were assessed for eligibility, yielding 246 articles describing 663 neonates. Neonates who tested negative had median Apgar scores of 9 and 9 at 1 and 5 mins, respectively, while test-positive neonates had median Apgar scores of 8 and 9 at the same time points. The proportions of test-negative neonates with Apgar scores below 7 were 29 (4%) and 11 (2%) at 1 and 5 mins, which was not statistically significant (p = 0.327, χ2 = 0.961). These proportions were even lower for positive neonates: 22 (3%) and 11 (2%) at 1 and 5 mins, respectively, which was not statistically significant (p = 1, χ2 = 0). The low proportion of Apgar scores below 7 suggests that low Apgar scores are likely to be associated with severe maternal COVID-19 symptoms during delivery rather than neonatal COVID-19. Therefore, this study indicated that Apgar scores are poor indicators of neonatal COVID-19 status.

Maternal and Neonatal Outcomes Associated With COVID-19 Infection in Pregnant Mothers Admitted in Tertiary Care Hospital in Central State of India

“…Calvert et al. stated that there were no or limited congenital anomalies due to COVID-19 infection during pregnancy in a population-based national cohort study [ 22 ]. Two IUD (0.50%) occurred during our study which might be, possibly due to the change in fetal heart rate, low APGAR, or fetal distress although until now, there has been a lack of data available regarding IUD due to COVID-19 complications.…”

Pregnancy outcomes in patients with COVID-19: A retrospective chart review and literature review

“…51 Similar to studies reporting low birthweight, the association of low Apgar scores and COVID-19 infection appears to depend on whether maternal infection 50 or the general population examined. 27 A review of 246 articles and 663 neonates determined that Apgar scores were a poor predictor of neonatal COVID-19 infection; 52 there is limited evidence to support vertical transmission of this infection. 53,54 In-depth analysis of the reasons for these observations on fetal outcomes is beyond the scope of this study.…”