Normal Apgar scores, used to assess the health of new-born babies, may conceal increased risk of serious illness, researchers warn today.
The new analysis finds that the lower end of the normal score is associated with worse outcomes than higher scores.
The Apgar score is based on complexion, pulse rate, reaction when stimulated, muscle tone, and breathing. It is usually measured at one, five, and ten minutes after birth. A score of less than seven is known to have implications for neonatal illness, death, and long term neurodevelopmental outcomes.
Dr Neda Razaz of the Karolinska Institutet, Stockholm, Sweden, and colleagues have investigated whether Apgar scores of seven, eight, and nine carry any risks, compared with ten.
In the BMJ today (8 May) they report on their analysis of 1,551,436 babies born at term between 1999 and 2016.
Compared with those with an Apgar score of ten, the team found that the risks for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among babies with lower Apgar scores, especially at five and ten minutes.
There was also a raised risk for babies whose score fell from ten at five minutes to nine at ten minutes, compared with a stable score of ten.
However, they point out that the risks are still low compared with babies with scores below the normal range.
They conclude: “Our findings provide strong evidence to support the proposition that the optimal Apgar score is ten at each time point, and all new-borns should be assigned an Apgar score at ten minutes, regardless of their score at one and five minutes.”
Razaz, N. et al. Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ 8 May 2019; doi: 10.1136/bmj.l1656
Leave a Reply