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. 2013 Jul 29;8(7):e69072.
doi: 10.1371/journal.pone.0069072. Print 2013.

The apgar score and infant mortality

Fei Li  1 , Ting Wu, Xiaoping Lei, Hao Zhang, Meng Mao, Jun Zhang
Affiliations

The apgar score and infant mortality

Fei Li et al. PLoS One. .

Abstract

Objective: To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period.

Methods: The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores.

Results: Among births with a very low Apgar score at five minutes (1-3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births.

Conclusions: The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of subjects included.
Figure 2
Figure 2. Neonatal (A) and post-neonatal mortality (B) by five-minute Apgar score and gestational age.
Figure 3
Figure 3. Survival curves in preterm (A) and term (B) births for White and Black infants by five-minute Apgar score from birth to 1 year.
Figure 4
Figure 4. Mortality rates for White, Black and Hispanic infants by five-minute Apgar score at gestational age of 24–36 weeks (A–C) and 37–41 weeks (D–F).
(A and D: Time of Infant Death≤1 Day, B and E: Time of Infant Death between 2 and 27 Days, C and F: Time of Infant Death≥28 Days).
Figure 5
Figure 5. Mortality rates for singleton births and twins by five-minute Apgar score at gestational age of 24–36 weeks (A–C) and 37–41 weeks (D–F).
(A and D: Time of Infant Death≤1 Day, B and E: Time of Infant Death between 2 and 27 Days, C and F: Time of Infant Death≥28 Days).
See this image and copyright information in PMC

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