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Am J Perinatol 2015; 32(13): 1268-1272
DOI: 10.1055/s-0035-1554803
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Apgar Score at 5 Minutes Is Associated with Mortality in Extremely Preterm Infants Even after Transfer to an All Referral NICU

Authors

  • Thomas Bartman

    1   Division of Neonatology, Department of Pediatrics, The Ohio State University, Columbus, Ohio

  • Roopali Bapat

    1   Division of Neonatology, Department of Pediatrics, The Ohio State University, Columbus, Ohio
    2   Small Baby Program, Nationwide Children's Hospital, Columbus, Ohio

  • Elizabeth M. Martin

    2   Small Baby Program, Nationwide Children's Hospital, Columbus, Ohio

  • Edward G. Shepherd

    1   Division of Neonatology, Department of Pediatrics, The Ohio State University, Columbus, Ohio
    2   Small Baby Program, Nationwide Children's Hospital, Columbus, Ohio

  • Leif D. Nelin

    1   Division of Neonatology, Department of Pediatrics, The Ohio State University, Columbus, Ohio
    2   Small Baby Program, Nationwide Children's Hospital, Columbus, Ohio
    3   Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Columbus, Ohio

  • Kristina M. Reber

    1   Division of Neonatology, Department of Pediatrics, The Ohio State University, Columbus, Ohio
    2   Small Baby Program, Nationwide Children's Hospital, Columbus, Ohio
Further Information

Publication History

05 February 2015

20 April 2015

Publication Date:
09 June 2015 (online)

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Abstract

Objective The Apgar score has been shown to have utility in predicting mortality in the extremely preterm infant in delivery hospital populations, where most mortality occurs within 12 hours of birth. We tested the hypothesis that the 5 minute Apgar score would remain associated with mortality in extremely preterm infants after transfer from the delivery hospital to an all referral neonatal intensive care unit at an average age of 10 days.

Study Design A retrospective analysis of 454 infants born at < 27 weeks gestation.

Results The median Apgar score was 3 at 1 minute (interquartile range [IQR] 2–6) and 6 at 5 minutes (IQR 4–7). The Apgar score increased from 1 to 5 minutes by 2.0 ± 1.7 (p < 0.001). In logistic regression modeling, an Apgar score of < 5 at 5 minutes was associated with an increased mortality (odds ratio 1.76 [95% confidence interval 1.06–2.94], p < 0.05), but not morbidities.

Conclusion Infants born at < 27 weeks gestation admitted to an all referral children's hospital at a mean age of 10 days with a 5 minute Apgar < 5 are at an increased risk of mortality. Our findings continue to support the importance of the Apgar score given at delivery even in the extremely preterm infant referred to a nondelivery children's hospital.

Keywords

extremely low birth weight - intraventricular hemorrhage - bronchopulmonary dysplasia - children's hospital