Apgar scores and gestational age can forecast neonatal death

In a preterm infant, gestational age has been shown to be a major factor in death within the first 28 days of life. A study in the New England Journal of Medicine takes a look at the joint effect of gestational age and the Apgar score on the risk of neonatal death.¹

The investigators used data from the Swedish Medical Birth Register. They identified 113,300 preterm infants, who had a gestational age of 22 weeks 0 days to 36 weeks 6 days, that were born from 1992 to 2016. They also looked at Apgar scores at 5 minutes and 10 minutes, as well as the change in the Apgar score between 5 minutes and 10 minutes.

In the cohort, there were 1986 neonatal deaths and the incidence of deaths ranged from 76.5% at 22 weeks of gestation and 0.2% at 36 weeks gestation. The researchers found that lower Apgar scores were linked to higher relative risks of neonatal death. Among infants who were born at 28 to 31 weeks, the adjusted absolute rate differences according to the 5-minute Apgar score, using the infants with a score of 9 or 10 as a reference group, it was 1.2 (95% CI, 0.5 to 1.9) for a score of 7 or 8; 7.1 (95% CI, 5.1 to 9.1) for score of 4 to 6; 25.5 (95% CI, 18.3 to 32.8) for a score of 2 or 3; and 51.7 (95% CI, 38.1 to 65.4) for a score of 0 or 1. When compared to a stable Apgar score between 5 minutes and 10 minutes, an increase in the score was linked to lower neonatal mortality.

The researchers concluded that both Apgar scores were able to give predictive information about whether preterm infants would die within 28 days of delivery.

Reference

1. Cnattingius S, Johansson S, Razaz N. Apgar score and risk of neonatal death among preterm infants. NEJM. 2020:383(1):49-57. doi:10.1056/nejmoa1915075