Background Apgar score is used to evaluate the neonates’ overall status and response to resuscitation, as well as its prognosis beyond the neonatal period. Low fifth minute Apgar scores is more frequent and is associated with markedly increased risks of neonatal mortality and morbidity. In Ethiopia, the prevalence of birth asphyxia is high (22.52%). Birth asphyxia contributes to significant neonatal morbidities and mortalities due to severe hypoxic-ischemic multi-organ damage, mainly brain damage. Therefore, this study was aimed to identify determinants of low fifth minute Apgar score among newborns delivered by cesarean section. Methods An unmatched case control study design was conducted. The Apgar score is based on measures of heart rate, respiratory effort, skin color, muscle tone, and reflex irritability. The data collection tool or checklist was adapted from previous study done at Addis Ababa, Ethiopia. In this study, cases were all newborns with Apgar score < 7 whereas controls were all newborns with Apgar score >  = 7. The study participants were selected by simple random sampling technique. Data was into Epidata version 4.6 and exported to SPSS software version 24. Multivariable logistic regression was used to identify the independent effect of different factors at P < 0.05. Result Factors associated with low Apgar score were fetal birth weight < 2.5 kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] P = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) P = 0.001, pregnancy induced hypertension (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) P = 0.002, antepartum hemorrhage (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, general anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) P = 0.001, meconium stained amniotic fluid (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) P = 0.009 and emergency cesarean section (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) P = 0.019. Conclusions Fetal birth weight < 2.5 kg, skin incision to delivery time, pregnancy induced hypertension, antepartum hemorrhage, type of anesthesia, meconium stained amniotic fluid and type of cesarean section were factors independently associated with Apgar score. Therefore, it is important to work on identified risk factors to reduce the impacts low fifth minute Apgar score in the in early adulthood..

Background Apgar score is a practical method of systemically assessing newborn baby immediately after birth to identify those requiring resuscitation and to predict survival in neonatal period. This study was aimed to identify determinant of low fifth minute Apgar score among newborns delivered by Cesarean section. Methods An unmatched case control study design was conducted. Cases were newborns with Apgar score of < 7; controls were newborns with an Apgar score of > = 7. The study participants were selected by simple random sampling technique. Data was entered into Epi data version 4.6 and exported to SPSS software version 24. Multivariable logistic regression to identify the independent effect of different factors at P < 0.05. Result In this study, factors associated with low Apgar score (LAS) were fetal birth weight < 2.5kg [adjusted odds ratio (AOR) = 8.17, 95% confidence interval (CI): 1.03 ‒ 64.59] p = 0.046, skin incision to delivery time (AOR = 5.27; 95% CI: 2.20 ‒ 12.60) p = 0.001, Pregnancy induced hypertension (PIH) (AOR = 4.58, 95% CI: 1.75 ‒ 11.92) p = 0.002, antepartum hemorrhage (APH) (AOR = 3.96; 95% CI: 1.75 ‒ 8.94) 0.001, type of anesthesia (AOR = 3.37, 95% CI: 1.72 ‒ 6.62) p = 0.001, meconium stained amniotic fluid (MSAF) (AOR = 3.07, 95% CI: 1.32 ‒ 7.12) p = 0.009 and type of cesarean section (CS) (AOR = 2.17, 95% CI: 1.13 ‒ 4.15) p = 0.019. Conclusions Fetal birth weight < 2.5kg, skin incision to delivery time, PIH, APH, type of anesthesia, MSAF and type of CS were independently associated with LAS. Therefore, it was strongly recommended that working on identified risk factors were paramount to improve then neonatal outcomes.