Refining the Apgar score cut-off point for newborns at risk

• Published in: Acta Paediatrica Vol. 93; no. 1; pp. 53 - 59
• Main Authors: Chong, DSY, Karlberg, J
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2004; Blackwell
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Apgar Score; Biological and medical sciences; birth register; Emergency and intensive care: neonates and children. Prematurity. Sudden death; General aspects; Humans; Infant Mortality; Infant, Newborn; Intensive care medicine; Medical Records; Medical sciences; mortality; neonatal; Predictive Value of Tests; Registries; Risk; ROC Curve; Sweden; Sweden; Human; Pediatrics; Neonatal; birth register; Mortality; Curve; Apgar score; Birth; Epidemiology; Newborn; Register; Receiver operating characteristic curves; ROC curve; Signal detection
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2004.tb00674.x

Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods: The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n= 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results: Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%). Conclusions: Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth.