Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context
Summary: Background: The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0–38+6 weeks), full term (39+0–40+6 weeks), late term (41+0–41+6 weeks), and post term (≥42...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606524000051 |
| _version_ | 1797356096265912320 |
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| author | Jesrine Hong Kylie Crawford Kate Jarrett Tegan Triggs Sailesh Kumar |
| author_facet | Jesrine Hong Kylie Crawford Kate Jarrett Tegan Triggs Sailesh Kumar |
| author_sort | Jesrine Hong |
| collection | DOAJ |
| description | Summary: Background: The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0–38+6 weeks), full term (39+0–40+6 weeks), late term (41+0–41+6 weeks), and post term (≥42+0 weeks) infants. Methods: This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4–6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Findings: Of the study cohort, 0.04% (345/941,221) were neonatal deaths, 0.70% (6627/941,221) were infants with severe neurological morbidity and 4.3% (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95% CI 560.96, 1318.94, p < 0.001); full term (aRRR 1835.77, 95% CI 1279.48, 2633.91, p < 0.001); late term (aRRR 1693.61, 95% CI 859.65, 3336.6, p < 0.001) and post term (aRRR 2231.59, 95% CI 272.23, 18293.07, p < 0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95% CI 118.74, 211.51, p < 0.001); full term (aRRR 112.99, 95% CI 90.56, 140.98, p < 0.001); late term (aRRR 87.94, 95% CI 67.09, 115.27, p < 0.001) and post term (aRRR 52.07, 95% CI 15.17, 178.70, p < 0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2–3 cohort (aRRR 7.36, 95% CI 6.2, 8.74, p < 0.001). Interpretation: A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks’ gestation with the risk greatest in the early term cohort. Funding: National Health and Medical Research Council and Mater Foundation. |
| first_indexed | 2024-03-08T14:20:40Z |
| format | Article |
| id | doaj.art-f19ff5367b154aaba8c86634f093c01e |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-03-08T14:20:40Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-f19ff5367b154aaba8c86634f093c01e2024-01-14T05:40:14ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652024-03-0144101011Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in contextJesrine Hong0Kylie Crawford1Kate Jarrett2Tegan Triggs3Sailesh Kumar4Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, MalaysiaMater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, AustraliaMater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, AustraliaMater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, AustraliaMater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, 4101, Australia; School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia; Corresponding author. Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.Summary: Background: The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0–38+6 weeks), full term (39+0–40+6 weeks), late term (41+0–41+6 weeks), and post term (≥42+0 weeks) infants. Methods: This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4–6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Findings: Of the study cohort, 0.04% (345/941,221) were neonatal deaths, 0.70% (6627/941,221) were infants with severe neurological morbidity and 4.3% (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95% CI 560.96, 1318.94, p < 0.001); full term (aRRR 1835.77, 95% CI 1279.48, 2633.91, p < 0.001); late term (aRRR 1693.61, 95% CI 859.65, 3336.6, p < 0.001) and post term (aRRR 2231.59, 95% CI 272.23, 18293.07, p < 0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95% CI 118.74, 211.51, p < 0.001); full term (aRRR 112.99, 95% CI 90.56, 140.98, p < 0.001); late term (aRRR 87.94, 95% CI 67.09, 115.27, p < 0.001) and post term (aRRR 52.07, 95% CI 15.17, 178.70, p < 0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2–3 cohort (aRRR 7.36, 95% CI 6.2, 8.74, p < 0.001). Interpretation: A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks’ gestation with the risk greatest in the early term cohort. Funding: National Health and Medical Research Council and Mater Foundation.http://www.sciencedirect.com/science/article/pii/S2666606524000051Apgar scoreNeonatal mortalityNeonatal morbidityNeurologicalTerm infant |
| spellingShingle | Jesrine Hong Kylie Crawford Kate Jarrett Tegan Triggs Sailesh Kumar Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context The Lancet Regional Health. Western Pacific Apgar score Neonatal mortality Neonatal morbidity Neurological Term infant |
| title | Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context |
| title_full | Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context |
| title_fullStr | Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context |
| title_full_unstemmed | Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context |
| title_short | Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort studyResearch in context |
| title_sort | five minute apgar score and risk of neonatal mortality severe neurological morbidity and severe non neurological morbidity in term infants an australian population based cohort studyresearch in context |
| topic | Apgar score Neonatal mortality Neonatal morbidity Neurological Term infant |
| url | http://www.sciencedirect.com/science/article/pii/S2666606524000051 |
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