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Outcome of infants with 10 min Apgar scores of 0–1 in a low-resource setting
  1. Thorkild Tylleskär1,
  2. Francesco Cavallin2,
  3. Susanna Myrnerts Höök3,4,
  4. Nicolas J Pejovic1,5,
  5. Clare Lubulwa6,
  6. Josaphat Byamugisha7,8,
  7. Jolly Nankunda9,
  8. Daniele Trevisanuto10
  9. NeoSupra Trial Team
    1. 1 Centre for International Health, Universitetet i Bergen, Bergen, Norway
    2. 2 Independent statistician, Solagna, Italy
    3. 3 Department of Public Health Sciences, University of Bergen, Bergen, Norway
    4. 4 Department of Public Health Sciences, Sachs’ Children and Youth Hospital, Stockholm, Sweden
    5. 5 Department of Neonatology, Sachsska Barnsjukhuset, Stockholm, Sweden
    6. 6 Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
    7. 7 Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
    8. 8 Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
    9. 9 Paediatrics and Child Health, Makerere University, Kampala, Uganda
    10. 10 Department of Woman's and Child's Health, University of Padova, Padova, Italy
    1. Correspondence to Dr Daniele Trevisanuto, Department of Women's and Child Health, University of Padova, Padova 35128, Italy; daniele.trevisanuto{at}


    Background In high-resource settings, postponing the interruption of cardiopulmonary resuscitation from 10 to 20 min after birth has been recently suggested, but data from low-resource settings are lacking. We investigated the outcome of newborns with Apgar scores of 0–1 at 10 min of resuscitative efforts in a low-resource setting.

    Methods This observational substudy from the NeoSupra trial included all 49 late preterm/full-term newborns with Apgar scores of 0–1 at 10 min of resuscitation. The study was carried out at Mulago National Referral Hospital (Kampala, Uganda) between May 2018 and August 2019. Outcome measures were mortality and hypoxic-ischaemic encephalopathy in the first week of life. All resuscitations were video recorded and daily reviewed by trial researchers.

    Results Median duration of resuscitation was 32 min (IQR 17–37). Advanced resuscitation was provided to 21/49 neonates (43%). Overall, 48 neonates (98%) died within 2 days of life (44 in the delivery room, three on the first day and one on the second day) and one survived at 1 week with severe hypoxic-ischaemic encephalopathy.

    Conclusion Our study adds information from a low-resource setting to the recent evidence from high-resource settings about prolonging the resuscitation in infants with Apgar scores of 0–1 at 10 min. The vast majority died in the delivery room despite prolonged resuscitative efforts. We confirm that duration of resuscitation should be tailored to the setting, while the focus in low-resource settings should be improving the quality of antenatal and immediately after birth care.

    • ethics
    • neonatology
    • resuscitation

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • TT and FC contributed equally.

    • Collaborators The NeoSupra Trial Team also includes Mats Blennow-Bohlin, Tobias Alfvén, Hege Ersdal, Hadija Nalubwama, Allan Mpamize, Damien K Wasswa, Anita Tumwebaze, Natalia Niombi, Sherinah Nakalembe, Sulphine Twinomuhangi and Dorothy Mugabi.

    • Contributors FC has contributed to data analysis, data interpretation and writing of the manuscript. SMH, NJP, JB and JN contributed to data collection and data interpretation, and critically reviewed the manuscript. TT and DT conceived the study, and contributed to data interpretation and writing of the manuscript. DT is the guarantor

    • Funding This substudy was part of the NeoSupra trial which was funded by a grant from the Research Council of Norway (RCN), FRIMEDBIO grant 250531 and the Centre for Intervention Science in Maternal and Child Health (CISMAC).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.