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Grand Rounds

Can Apgar Scores Help Predict Neonatal Mortality for Preterm Infants at Different Gestational Ages?

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BACKGROUND AND PURPOSE:

  • The clinical value of low Apgar scores is not well understood for preterm infants
  • Cnattingius et al. (NEJM, 2020) examined the associations between the risk of neonatal death and Apgar scores at 5 and 10 minutes among preterm infants stratified according to gestational age

METHODS:

  • Secondary analysis of a prospective cohort study
  • Data source
    • Swedish Medical Birth Register
  • Participants
    • Preterm infants (22w0d to 36w6d)
    • Born between 1992 and 2016
  • Study design
    • Analyses were stratified according to gestational age
      • 22 to 24 weeks | 25 to 27 weeks | 28 to 31 weeks | 32 to 34 weeks | 35 weeks | 36 weeks
    • Reference group: Neonates with scores of 9 or 10
    • The authors estimated the following with respect to 5 and 10 minute Apgar scores
      • Adjusted relative risks (RR) of neonatal death
      • Absolute rate differences in neonatal mortality (excess number of neonatal deaths per 100 births)
  •  Primary outcome
    • Neonatal mortality (death within first 27 days of life)

RESULTS:

  • 113,300 preterm infants were included
    • Neonatal deaths: 1.8%
  • Incidence of neonatal death ranges from
    • 36 weeks: 0.2%
    • 22 weeks: 76.5%
  • In all gestational-age strata, lower Apgar scores were associated with both
    • Higher RRs of neonatal death
    • Greater absolute rate differences in neonatal mortality
  • For infants born at 28 to 31 weeks, adjusted absolute rate differences according to the 5-minute Apgar score were as follows
    • Score 0 or 1: 51.7 (95% CI, 38.1 to 65.4)
    • Score 2 or 3: 25.5 (95% CI, 18.3 to 32.8)
    • Score 4 to 6: 7.1 (95% CI, 5.1 to 9.1)
    • Score 7 or 8: 1.2 (95% CI, 0.5 to 1.9)
  • An increase in the Apgar score between 5 minutes and 10 minutes was associated with lower neonatal mortality compared to a stable Apgar scores
    • This finding was consistently seen even among neonates with normal Apgars (e.g., increase from 7 or 8 to 9 or 10)

CONCLUSION:

  • Apgar scores at 5 and 10 minutes are predictive for neonatal survival in preterm infants
  • There is a dose–response associations between Apgar score and risks of neonatal death
  • The authors state

In this nationwide study, 5-minute and 10-minute Apgar scores and changes in the score between 5 minutes and 10 minutes were associated with neonatal mortality among preterm infants across gestational ages

Learn More – Primary Sources:

Apgar Score and Risk of Neonatal Death among Preterm Infants


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Related ObG Topics:

The Latest Outcomes Data on Adults Who Were Born Preterm
Are Lower Normal Apgar Scores Associated with Higher Risk of Adverse Neonatal Outcomes?
5 and 10 Minute Apgar Scores: What is Their Relationship with Cerebral Palsy and Epilepsy?

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