Objective Evaluate the risk factors and immediate outcome of term neonates born with Apgar Score (AS) of <7 at 5 minutes.

Methods Retrospective review of maternity database to identify 187 live born neonates with AS <7 @ 5 minutes, during a 2 year period, in a large tertiary care unit in N.Ireland. Excluding multiple pregnancies and neonates born preterm or with congenital malformations, a sample of 57 term neonates were identified for analysis of case notes.

Results 63% of mothers were primigravida, at 37 weeks or more, with 54% of them being forty weeks or more at delivery. Only 28% of pregnancies were known to be high risk at the onset of labour while 73% of low risk pregnancies developed intrapartum risk factors such as maternal pyrexia, tachycardia and meconium. Only 7.3% experienced significant intrapartum events (abruption, shoulder dystocia). 37% of all neonates were admitted to the neonatal unit with 62% of them needing intubation. 92% of babies needing intubation were from low risk pregnancies who developed intrapartum risk factors, most of which were not recognised and acted upon appropriately.

Conclusion Low AS in term neonates seems to be associated with new onset of intrapartum risk factors rather than pre-exiting risk factors. Birth attendants should pay more attention to early recognition of risk factors through continuous risk assessment, and intervene appropriately, in order to prevent unexpected poor neonatal outcome.