Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden

• Published in: BMJ (Online) Vol. 365; p. l1656
• Main Authors: Razaz, Neda, Cnattingius, Sven, Joseph, KS
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 07.05.2019; BMJ Publishing Group Ltd
• Subjects: Age; Apgar score; Asphyxia; Babies; Births; Body mass index; Cerebral palsy; Cohort analysis; Education; Gestation; Hypoglycemia; Hypoxia; Infant mortality; Infants; Medicin och hälsovetenskap; Morbidity; Mortality; Mothers; Neonates; Newborn babies; Obesity; Obstetrics; Population; Population studies; Population-based studies; Sweden
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.l1656

AbstractObjectiveTo investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity.DesignPopulation based cohort study.SettingSweden.Participants1 551 436 non-malformed live singleton infants, born at term (≥37 weeks’ gestation) between 1999 and 2016, with Apgar scores of ≥7 at 1, 5, and 10 minutes.ExposuresInfants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively.Main outcome measuresNeonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated.ResultsCompared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes.ConclusionsIn term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).