Apgar Score at 1^st Minute: Early Prognostic Value?

Background: Apgar score (AS) provides a standardized reporting method for newborn status. Low 5-minute-AS correlates with neonatal complications. Although a low 1-minute-AS does not predict any individual infant’s long-term outcome, there is lack of scientific data for the implications in the first days.

Objective: To evaluate low 1-minute-AS implications in the newborn first days.

Methods: Retrospective case-control study, matched by gestational age (1:2). All newborns with 1-minute-AS≤5 from a Portuguese level II hospital, between 2017 and 2018, were included. A 5-minute-AS≥8 subgroup was considered to exclude bias from known poor prognosis of a low 5-minute-AS.

Results: Included 85 cases with no differences in sex, gestational age and birth weight from the controls (170). Deaths occurred only in the sample group (n=3).

Sample group had more alterations in cardiotocography (41% vs 4%, p<0.001), meconium (24% vs 5%, p<0.001), intubation (29% vs 1%, p<0.001), intermittent positive pressure ventilation (IPPV) (88% vs 1%, p<0.001) and compressions (5% vs 0%, p=0.011).

First-minute-AS≤5 was associated with more respiratory distress syndrome (31% vs 2%, p<0.001), Neonatal Intermediate Care Unit (NICU) needed (57% vs 11%,p<0.001) and longer hospitalization (median 4 vs 3,p<0.001). They required more umbilical catheterization (20% vs 4%,p<0.001), intravenous fluids (54% vs 11%,p<0.001), ventilation support (13% vs 5%,p=0.03), antibiotherapy (33% vs 9%, p<0.001), nasogastric tube feeding (16% vs 7%,p=0.016) and phototherapy (31% vs 15%,p=0.003). These newborns were less exclusively breastfeeding than controls (53% vs 75%, p<0.001).

In the 5-minute-AS≥8 subgroup (n=40) differences remained statistically significative (p<0,05) regarding to cardiotocography, meconium, intubation, IPPV and compressions. This subgroup experienced more respiratory distress syndrome, NICU stay, intravenous fluids, antibiotherapy and longer hospitalization.

Conclusion: First-minute-AS≤5 (even when 5-minute-AS≥8) has important implications on the first days of life. Newborns needed more medical care which possibly increased costs. Other factors such as long maternal breastfeeding and microbiome may have been compromised.