Outcome in relation to Apgar score in term neonates
Misra, P.K.; Srivastava, N.; Malik, G.K.; Kapoor, R.K.; Srivastava, K.L.; Rastogi, S.
Indian Pediatrics 31(10): 1215-1218
1994
ISSN/ISBN: 0019-6061 PMID: 7875781 Document Number: 288686
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.