Outcome in relation to Apgar score in term neonates

Abstract

Sixty four asphyxiated term babies (Apgar score of 6 or less at 5 minutes) and 90 non-asphyxiated term babies (controls) were studied. Of these, 40 cases and 48 controls could be followed up. Mortality and neurodevelopmental outcome were studied in both the cases and controls. Mortality and poor neurodevelopmental outcome correlated inversely with the Apgar scores at 5 and 10 minutes. The outcome of babies with low 5 minute Apgar scores was significantly better than those with the same scores at 10 minutes. Symptomatic neonates when compared to asymptomatic neonates with same Apgar score showed significantly poorer outcome. Babies with Apgar scores of 6 at 5 or 10 minutes behaved like the controls both in terms of mortality and neurodevelopmental outcome.

PIP: In India, pediatricians followed 64 term asphyxiated newborns (Apgar score =or 6) and 90 term nonasphyxiated newborns born at Queen Mary's Hospital in Lucknow to compare their outcomes in terms of mortality and neurodevelopment. They determined their Apgar scores at 5 and 10 minutes. Neonatal mortality increased as the 5-minute Apgar score decreased (5.6% for controls [=or 7], 6.3% for 6, 20% for 5, 25% for 4, and 63.3% for 0-3). It was significantly higher for the 10-minute Apgar groups (16.7% for 6, 33.3% for 5, 40% for 4, and 77.8% for 0-3). 100% and 33.3% of newborns with 5-minute Apgar scores of 0-3 and 4-6, respectively, were symptomatic. Their neonatal mortality rates were 66.6% and 33.3%, respectively. None of the asymptomatic newborns with 5-minute Apgar scores of 4-6 died. At 3, 7, and 11 months follow-up, the neurodevelopmental outcome of infants whose 5-minute Apgar score was 6 was similar to that of the controls. It was better than those with lower 5-minute Apgar scores, especially scores of 0-3 at 3 months (normal development, 91.7% vs. 42.8%; p 0.05). These findings suggest that a 5-minute Apgar score of 6 should not be considered asphyxia (i.e., scores of 5 or less should denote asphyxia). They also show that the Apgar score should be repeated at 10 minutes so health providers can better predict neurodevelopmental outcome.