The 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.
An 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.
Less 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.
A 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.
American Academy of Pediatrics, Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. The Apgar score. Pediatrics. 2006;117:1444–7. CrossRef
Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar Score and Infant Mortality. PLoS ONE [Internet]. 2013 [cited 2015 Mar 18];8. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726736/. Accessed 03 Apr 2017.
Vahabi S, Haidari M, Akbari Torkamani S, Gorbani VA. New assessment of relationship between Apgar score and early neonatal mortality. Minerva Pediatr. 2010;62:249–52. PubMed
Sun Y, Vestergaard M, Pedersen CB, Christensen J, Olsen J. Apgar scores and long-term risk of epilepsy. Epidemiol Camb Mass. 2006;17:296–301. CrossRef
Mikkelsen C, International Working Group for Indigenous Affairs. The indigenous world 2014. Copenhagen: IWGIA; 2014.
Department of Statistic, Malaysia. Department of Statistics Malaysia Official Portal [Internet]. Malays Glance. 2015 [cited 2015 Aug 19]. Available from: https://www.statistics.gov.my/index.php?r=column/cone&menu_id=dDM2enNvM09oTGtQemZPVzRTWENmZz09. Accessed 03 Apr 2017.
Jeganathan R, Karalasigam SD. Preliminary report of National Obstetrics Registry, Jan-December 2010. Kuala Lumpur: National Obstetrics Registry, Ministry of Health Malaysia; 2013.
Jeganathan R, Karalasingam SD. Preliminary report of the National Obstetrics Registry: July-December 2009. Kuala Lumpur: National Obstetrics Registry, Ministry of Health Malaysia; 2011. Report No.: MOH/S/CRC/18.11(AR).
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet Lond Engl. 2004;363:157–63. CrossRef
R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria; 2017. Available from: http://www.R-project.org/. Accessed 03 Apr 2017.
Reidpath DD, Karalasingam SD, Jeganathan R, Hussein J, Allotey P. Bivariate distribution of Apgar scores at 1 and 5 minutes. [Internet]. 2017. Available from: http://dx.doi.org/10.4225/03/55EFA4912544D
Mongelli M, Rogers MS, Brieger GM. Obstetric determinants of low Apgar scores in a Chinese population. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1997;57:67–8. CrossRef
Kovavisarach E, Juntasom C. Risk factors of delivery of low apgar score newborn below 7 at 1 minute: a case–control study. J Med Assoc Thail Chotmaihet Thangphaet. 1999;82:660–5.
Haddad B, Mercer BM, Livingston JC, Sibai BM. Obstetric antecedents to apparent stillbirth (Apgar score zero at 1 minute only). Obstet Gynecol. 2001;97:961–4. PubMed
Johantgen M, Fountain L, Zangaro G, Newhouse R, Stanik-Hutt J, White K. Comparison of labor and delivery care provided by certified nurse-midwives and physicians: a systematic review, 1990 to 2008. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2012;22:e73–81. CrossRef
Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM. Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2006;3:CD004660. https://www.ncbi.nlm.nih.gov/pubmed/16856054.
Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GM. Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2012;3:CD004660. https://www.ncbi.nlm.nih.gov/pubmed/22419296.
Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Selander T, Heinonen S. Pregnancy outcomes of overweight and obese women aged 35 years or older - A registry-based study in Finland. Obes Res Clin Pract. 2016;10(2):133-42.
Avcı ME, Sanlıkan F, Celik M, Avcı A, Kocaer M, Göçmen A. Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2014;1–4.
Wielandt HB, Schønemann-Rigel H, Holst CB, Fenger-Grøn J. High risk of neonatal complications in children of mothers with gestational diabetes mellitus in their first pregnancy. Dan Med J. 2015;62(6).
Ovesen PG, Jensen DM, Damm P, Rasmussen S, Kesmodel US. Maternal and neonatal outcomes in pregnancies complicated by gestational diabetes. a nation-wide study. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2015;28:1720–4.
Fairley L, Petherick ES, Howe LD, Tilling K, Cameron N, Lawlor DA, et al. Describing differences in weight and length growth trajectories between white and Pakistani infants in the UK: analysis of the Born in Bradford birth cohort study using multilevel linear spline models. Arch Dis Child. 2013;98:274–9. CrossRefPubMedPubMedCentral
Penfield CA, Cheng YW, Caughey AB. Obstetric outcomes in adolescent pregnancies: a racial/ethnic comparison. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2013;26:1430–4.
Flores MES, Simonsen SE, Manuck TA, Dyer JM, Turok DK. The “Latina epidemiologic paradox”: contrasting patterns of adverse birth outcomes in U.S.-born and foreign-born Latinas. Womens Health Issues Off Publ Jacobs Inst Womens Health. 2012;22:e501–7. CrossRef
Tarmiji Masron, Fujimaki Masami, Norhasimah Ismail. Orang Asli in Peninsular Malaysia : Population, Spatial Distribution and Socio-Economic Condition. J Ritsumeikan Soc Sci Humanit. 2013;6:75–115.
Indra P, Jerker L, Martins JM, Rajapaksa LC, Craig L, de Silva A, et al. Investing in maternal health: learning from Malaysia and Sri Lanka. Washington D.C.: World Bank; 2003.
Economic Planning Unit, Prime Minister’s Department Malaysia. Official Website of Economic Planning Unit - Household Income & Poverty [Internet]. 2015 [cited 2015 Sep 16]. Available from: http://www.epu.gov.my/en/socio-economic/household-income-poverty. Accessed 03 Apr 2017.
Carpenter J, Kenward M. Multiple Imputation and its Application. Chichester: John Wiley & Sons; 2013.
O’Reilly GM, Jolley DJ, Cameron PA, Gabbe B. Missing in action: a case study of the application of methods for dealing with missing data to trauma system benchmarking. Acad Emerg Med Off J Soc Acad Emerg Med. 2010;17:1122–9. CrossRef
Zehtabchi S, Nishijima DK, McKay MP, Mann NC. Trauma registries: history, logistics, limitations, and contributions to emergency medicine research. Acad Emerg Med Off J Soc Acad Emerg Med. 2011;18:637–43. CrossRef
Rüdiger M, Küster H, Herting E, Berger A, Müller C, Urlesberger B, et al. Variations of Apgar score of very low birth weight infants in different neonatal intensive care units. Acta Paediatr Oslo Nor 1992. 2009;98:1433–6.
O’Donnell O, Doorslaer EV, Wagstaff A, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, D.C: World Bank; 2008.
- 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
Shamala D. Karalasingam
Daniel D. Reidpath
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II