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PP.03 Does the Apgar Score Matter? Investigating the Relationship Between a Low Score and Adverse Outcomes from Birth to Childhood
  1. GL Malin2,
  2. RK Morris1,
  3. S Ahmad4,
  4. R Riley1,
  5. KS Khan3
  1. 1University of Birmingham, Birmingham, UK
  2. 2University of Nottingham, Nottingham, UK
  3. 3The Blizard Institute, Barts and the London School of Medicine, London, UK
  4. 4The Royal Derby Hospital, Derby, UK


Background A low Apgar score at birth may occur for a variety of reasons. Existing evidence regarding the long term implications is conflicting.

Methods Systematic review of the literature, with random effects meta-analysis.

Results 87 manuscripts were included, with a total of 3,690,080 neonates. A low Apgar score was strongly associated with neonatal mortality in a population born at term (≥ 37 weeks gestation), or with normal birth weight (≥ 2.5 kg) (10 minute Apgar score ≤ 3: OR 1417.75, 95% CI 915.99 to 2194.36). Raising the Apgar score at a particular time reduced the strength of association. In a pre-term population, the association was smaller (10 minute score ≤ 3: OR 66.49, 95% CI 45.00 to 98.22). For neonatal morbidity, significant association was seen at a number of thresholds. In a term population, there was a significant association between a low Apgar score and cerebral palsy at all thresholds examined, with the largest association seen at a 5 minute Apgar score ≤ 3 (3 studies, OR 46.35, 95% CI 11.21 to 191.59). When the predictive ability of a low Apgar score was considered, the specificity and positive likelihood ratios were generally high, however the corresponding sensitivity and negative likelihood ratios were low.

Conclusion A low Apgar score at birth is strongly associated with neonatal mortality, morbidity and childhood cerebral palsy, particularly in a term or normal birth weight population. Further research is required to identify the threshold at which the Apgar score may best predict adverse outcomes.

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