Neonates with a 10-min Apgar score of zero: Outcomes by gestational age

The current resuscitation guidelines for neonates recommend considering stopping resuscitation efforts if the heart rate remains undetectable after 10 min of adequate resuscitation. However, this recommendation does not take into account the gestational age (GA) of the neonates. We determined the outcomes of neonates with a 10-min Apgar score of zero (Apgar¹⁰ = 0) with respect to their GA.

In a retrospective matched cohort study, we studied neonates admitted to the Canadian Neonatal Network NICUs between 2010 and 2016 with an Apgar¹⁰ = 0. The neonates were divided into 3 subgroups according to their GA: (1) ≥36 weeks', (2) 32^0/7-35^6/7 weeks', and (3) <32 weeks'. Each neonate with Apgar¹⁰ = 0 was matched 1:1 with neonates of same GA and sex but Apgar¹⁰ = 1-2 and Apgar¹⁰ = 3-5. Survival and brain injury were compared between matched groups.

177 neonates had Apgar¹⁰ = 0. Survival to discharge was significantly different between GA groups [≥36 weeks' 61% vs. 32^0/7-35^6/7 weeks' 58% vs. <32 weeks' 35%, p = 0.04]. Survival to discharge was similar to their matched cohort with Apgar¹⁰ = 1-2 for neonates born at ≥36 weeks' (61% vs. 66%) and between 32^0/7 to 35^6/7 weeks' (58% vs. 54%), but significantly different for neonates <32 weeks (35% vs. 61%, p = 0.04).

Neonates with Apgar¹⁰ = 0 had different outcomes depending on their GA. Less than half of neonates born at <32 weeks GA survived; however, a majority of neonates born at 32^0/7-35^6/7 weeks' and ≥36 weeks' GA survived at similar rates than their matched neonates with Apgar¹⁰ = 1-2.