Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010–2012

Abstract

BackgroundThe neonatal Apgar score at 5 min has been found to be a better predictor of outcomes than the Apgar score at 1 min. A baby, however, must pass through the first minute of life to reach the fifth. There has been no research looking at predictors of recovery (Apgar scores ≥7) by 5 min in neonates with 1 min Apgar scores <4.MethodsAn analysis of observational data was conducted using live, singleton, term births recorded in the Malaysian National Obstetrics Registry between 2010 and 2012. A total of 272,472 live, singleton, term births without congential anomalies were recorded, of which 1,580 (0.59%) had 1 min Apgar scores <4. Descriptive methods and bi- and multi-variable logistic regression were used to identify risk factors associated with recovery (5 min Apgar score ≥7) from 1 min Apgar scores <4.ResultsLess than 1% of births have a 1 min Apgar scores <4. Only 29.4% of neonates with 1 min Apgar scores <4 recover to a 5 min Apgar score ≥7. Among uncomplicated vaginal deliveries, after controlling for other factors, deliveries by a doctor of neonates with a 1 min Apgar score <4 had odds of recovery 2.4 times greater than deliveries of neonates with a 1 min Apgar score <4 by a nurse-midwife. Among deliveries of neonates with a 1 min Apgar score <4 by doctors, after controlling for other factors, planned and unplanned CS was associated with better odds of recovery than uncomplicated vaginal deliveries. Recovery was also associated with maternal obesity, and there was some ethnic variation – in the adjusted analysis indigenous (Orang Asal) Malaysians had lower odds of recovery.ConclusionsA 1 min Apgar score <4 is relatively rare, and less than a third recover by five minutes. In those newborns the qualification of the person performing the delivery and the type of delivery are independent predictors of recovery as is maternal BMI and ethnicity. These are associations only, not necessarily causes, and they point to potential areas of research into health systems factors in the labour room, as well as possible biological and cultural factors.

Maternal and neonatal characteristics that influence very early neonatal mortality in the Eastern Regional Hospital of Ghana, Koforidua: a retrospective review

“…Other studies have tried to establish an association between multi-parity and low Apgar score at 5 min [ 9 ]. Earlier studies have investigated the factors influencing associations between 1 min Apgar score and poor neonatal outcome and have identified birth weight, and prematurity to be the neonatal and maternal factors contributing to deaths among neonates which is partially consistent with this current study [ 10 ]. Low birth weight babies had 2.07 times the odds of death as compared with normal weight babies which is consistent with the study conducted in Nigeria and Brazil [ 8 , 11 ].…”

The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia

“…Furthermore, it provides acumen into health system issues in the intrapartum period. Understanding the factors associated with the transition between the 1st minute Apgar score and 5th minute Apgar score has the potential to provide time for intervention or further investigation [13]. For this reason, the Apgar score at 5 min is a better forecaster of later outcomes than the Apgar score at 1 min [4].…”

A Decision-Tree Approach to Assist in Forecasting the Outcomes of the Neonatal Brain Injury

“…Moreover, Garfinkle et al indicated a greater than five odds ratios for an adverse outcome ( p < 0.05) in the case of AS1 ≤ 3 and AS5 ≤ 5 [ 5 ]. Furthermore, in many papers, AS1 (<4) was independently associated with an adverse outcome [ 6 , 8 , 14 , 54 ]. To summarize, the lower AS1 and AS5 scores are, the higher risks for an adverse outcome [ 11 , 14 , 44 , 45 , 51 ].…”