Are Lower Normal Apgar Scores Associated with Higher Risk of Adverse Neonatal Outcomes?
BACKGROUND AND PURPOSE:
Apgars <7 associated with neonatal mortality, morbidity, and adverse long-term outcomes
A recent study by the authors (see ‘Related ObG Topics’ below) demonstrated an association between low normal Apgar scores (7-9) and a higher risk for adverse long-term outcomes (primarily neurologic outcomes)
Apgar scores of 9195 were associated with increased risk of cerebral palsy compared with 101105
Limited data regarding increased risk of low normal Apgars with neonatal mortality and morbidity
Razaz et al. (BMJ, 2019) sought to determine whether there is an association between Apgar scores and neonatal mortality and morbidity
Population-based cohort study
Non-anomalous live singleton infants
Term (≥37 weeks’ gestation)
Apgar scores of ≥7 at 1, 5, and 10 minutes
Infants with Apgar scores of 7, 8, and 9 at 1,
5, and 10 minutes
Infants with Apgar score of 10 at 1, 5, and 10
Asphyxia related complications
Adjusted odds ratios (aOR), adjusted rate
differences (aRD), and 95% confidence intervals were estimated
1,551,436 over 18 years (1999-2016)
Apgar score of 10
1 minute: 11%
5 minutes: 89%
10 minutes: 97%
Compared to Apgar score of 10, especially at 5 and 10 minutes, Apgar scores of 7-9 were associated with increased risks for
RDS: aRDs when compared against an Apgar score of 10 at 10 minutes
Apgar score of 9 at 10 minutes: 9.5% (95% CI, 9.2% to 9.9%)
Apgar score of 7 at 10 minutes: 41.9% (95% CI, 37.7% to 46.4%)
Neonatal morbidity was associated with an Apgar score drop from 10 at 5 minutes to 9 at 10 minutes vs stable score of 10
Pregnancy complications (e.g., preeclampsia, chorioamnionitis, placental abruption) were associated with low normal Apgars
Infants with lower Apgar scores within the
normal range (7-9) were at a higher risk of neonatal mortality and morbidity and
may be “early prognostic indicators” that pregnancy complications may be having
an impact on the neonate
This risk for increased morbidity and mortality
were especially concerning when there was a drop in Apgar score from 10 to 9
between 5 and 10 minutes
The authors conclude
Although Apgar scores at 10 minutes are often not recorded in the medical charts if scores are within the normal range (7 to 10) at 5 minutes, our findings suggest that all newborns should be assigned an Apgar score at 10 minutes, regardless of their score at 1 minute and 5 minutes.
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