Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in term infants – An Australian population-based cohort study — ASN Events
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Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in term infants – An Australian population-based cohort study (#59)

Jesrine Hong 1 2 3 , Kylie Crawford 1 , Kate Jarrett 1 , Tegan Triggs 1 , Sailesh Kumar 1 2 4
  1. Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia
  2. School of Medicine, The University of Queensland, Herston, Queensland, Australia
  3. Department of Obstetrics & Gynaecology, Faculty of Medicine, Kuala Lumpur, Malaysia
  4. NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, South Brisbane, Queensland, Australia

Objective: To ascertain risks of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity related to the 5-minute Apgar score in early term, full term, late term, and post term infants.

Methods: A retrospective cohort study of 941,221 term singleton births between 2000–2018 in Queensland, Australia. Apgar scores at 5-minutes were categorized into five groups: Apgar 0 or 1, 2 or 3, 4 to 6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. 3 specific neonatal study outcomes were considered: 1)Neonatal mortality 2)Severe neurological morbidity and 3)Severe non-neurological morbidity. Poisson multivariable regression models were used.

Results: Of the study cohort, 0.04%(345/941,221) were neonatal deaths, 0.70%(6,627/941,221) were infants with severe neurological morbidity and 4.3%(40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios(aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term(aRRR 860.16, 95%CI 560.96, 1318.94,p<0.001); full term(aRRR 1835.77, 95%CI 1279.48, 2633.91,p<0.001); late term(aRRR 1693.61, 95%CI 859.65, 3336.6,p<0.001) and post term(aRRR 2231.59, 95%CI 272.23, 18293.07,p<0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95%CI 118.74, 211.51,p<0.001); full term(aRRR 112.99, 95%CI 90.56, 140.98,p<0.001); late term(aRRR 87.94, 95%CI 67.09, 115.27,p<0.001) and post term(aRRR 52.07, 95%CI 15.17, 178.70,p<0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2 to 3 cohort(aRRR 7.36, 95% CI 6.2, 8.74,p<0.001).

Conclusion: The 5-minute Apgar score was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity with the risk greatest in early term infants.

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