Low apgar score at birth11/14/2023 ![]() In Sweden, an increase in the prevalence of five-minute Apgar scores < 7 was reported between 19 explanations offered for the rise included increasing prevalence of multiple births, growing immigrant population, and more frequent use of epidural anesthesia. 10 The lower proportion of infants with scores < 7 in Scandinavia may reflect social and ethnic homogeneity, combined with uniform access to obstetric care. The reported specific prevalences for year 2000 are 0.7% in Denmark 9 and 1.4% in the United States. In developed countries, about 1% of newborns have Apgar score < 7 at five minutes. Risk factors for low Apgar scores include abnormalities of gestational length and prenatal growth congenital malformations as well as health, demographic, and socioeconomic characteristics of the parents 7, 8 ( Table 2). Therefore, unless specified otherwise, the term ‘low Apgar score’ in this review will refer to a score < 7. Because very small proportion of newborns have Apgar scores in the 0–3 range, research studies often examine outcomes among infants with low and intermediate scores combined (<7). 3 The categories were defined based on the observed neonatal mortality patterns. ![]() Apgar suggested categorizing her score as low (0–3), intermediate (4–6), and normal (7–10). In order to reduce the ‘noise’ from the partially subjective nature of the scoring (eg, the “color” component) Dr. 6 If an infant does not improve sufficiently after five minutes, Apgar score may be continuously measured (for up to 25 minutes postpartum) to assess the effectiveness of continuing resuscitation. Most, but not all, infants with a low one-minute score reach a five-minute score in the 7–10 range. The five-minute Apgar score reflects response to resuscitation among infants in whom it was initiated. 2 Thus, with the exception of a small proportion of infants whose resuscitation begins seconds after birth, one-minute Apgar score reflects a natural condition at one minute after both head and feet emerge from the birth canal. A second measurement, at five minutes of age, was subsequently added, and it has been used to assist in judging the effectiveness of resuscitation, if initiated in response to a low one-minute score. The score was initially measured at one minute after birth. Nevertheless, the observed associations point to the importance of fetal and perinatal periods for neurodevelopment.Īpgar score was quickly adopted for use worldwide, becoming “common currency” 5 among perinatologists. The low magnitude of absolute risks makes Apgar score a poor clinical predictor of long-term outcome. The absolute risks, however, are low (<5% in for most neurologic conditions), and majority of surviving babies with low Apgar scores grow up without disability. ![]() Some corresponding relative risk estimates are large (eg, four to seven for epilepsy or more than 20 for cerebral palsy), while others are modest (eg, 1.33 for impaired cognitive function). The association of Apgar score <7 at five minutes with increased risks of neurologic disability seems to persist many years postnatally. Dose-response patterns have been shown for the value of Apgar score and duration of low score and the outcomes of mortality and neurologic disability. The author concludes that the overall evidence shows consistent association of low Apgar scores with increased risks of neonatal and infant death and with neurologic disability, including cerebral palsy, epilepsy, and cognitive impairment. Apgar score was never intended for prediction of outcome beyond the immediate postnatal period however, since low scores correlate with prenatal and perinatal adversities, multiple studies have examined the relation between the value of Apgar score and duration of low (<7) Apgar score and subsequent death or neurologic disability. It has been used worldwide to evaluate infants’ condition immediately after birth, to determine their need for resuscitation, and to evaluate the effectiveness of resuscitation. Apgar score was devised with the aim to standardize the assessment of newborns.
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