New assessment of relationship between Apgar score and early neonatal mortality

Apgar scoring system was proposed in 1952 for evaluating the physical condition of neonates at 1 and 5 minutes after delivery. We designed this study to examine the original intent of Apgar system to predict neonatal survival during almost 50 years of its application.

We carried out a prospective cohort analysis of 1161 live born term neonates delivered by cesarean section at 37 weeks of gestation or later at Khoram-abad Asali hospital in Iran during 2003 to 2005. Apgar score in 1 and 5 minutes after delivery were determined and charted. We evaluated two groups, neonates with Apgar score of equal or more than 5 in 5 minute after birth, and the ones with less than 5. The relation between neonatal mortality during first 48 hours after birth and 5 minute Apgar score was assessed. All analysis was performed with SPSS Software and chi(2) test.

In 1161 neonates, 8 were with five minute Apgar score less than 5, and their mortality rate in first 48 hours after birth was 5, as compared with 13 in 1153 for neonates with 5 minute Apgar score equal or more than 5. Neonatal mortality rate was 625 in 1000 for neonates with 5 minute Apgar score less than 5 and 11.4 in 1000 for infants with score equal or more than 5. There was statistically significance between two groups (P approximately = 0.0001).

Apgar score is still as meaningful as it was in 1952. Apgar score after birth can be used as a rapid method for assessing the survival of neonate. Although low 5 minute Scores were rare in this study but there was strongly predictive relation between it and early neonatal mortality.