Original researchLow 5-minute Apgar score: a population-based register study of 1 million term births1☆,
Section snippets
Materials and methods
The study was based on data from the Swedish Medical Birth Registry, compiled of copies of medical records from antenatal care, delivery, and the pediatric examination of the newborn. It covers whole Sweden and contains data on 98–99% of all deliveries. A quality analysis of the register has been published.2
We analyzed data for 10 years (1988–1997) when 1,121,992 children were born according to official birth statistics, 98.9% (1,109,826) of whom were registered. Infants born before 37
Results
The study included 1,028,705 term infants of whom 7787 (0.76%) had 5-minute Apgar scores below 7 and 2155 (0.21%) below 4. The rate of infants with 5-minute Apgar score below 7 decreased from 0.77% in 1988 to 0.63% in 1992, then increased continuously to 0.82% in 1997 (Figure 1). An increased rate of low Apgar score during 1997 (OR 1.16, CI 1.07, 1.26) remained after excluding multiple births (OR 1.15, CI 1.06, 1.26), deliveries with epidural analgesia (OR 1.13, CI 1.02, 1.26), births of
Discussion
The Swedish Medical Birth Registry, providing data on 98–99% of births in Sweden, is one of the most complete birth registers in the world. We used the register to perform a population-based study on term infants with low Apgar score at 5 minutes after birth.
A low Apgar score is not a specific indicator of birth asphyxia because there may be other causes of this depression at birth. In this study, we excluded the two most apparent, prematurity and severe malformations. Biochemical markers,
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This study was supported by grants from the Medical Faculty of Lund University, the Swedish Medical Research Council (Project No. 4732), the Axel and Margaret Axelsson-Johnson Foundation, the Royal Physiographic Society, First of May Flower Annual Foundation, and the Sven Jerring Foundation.
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We are grateful to the National Board of Health and Welfare, Stockholm, Sweden, for providing data from registers, and greatly thank professor Bengt Källén at the Tornblad Institute for statistical advice.