Associations between provider-assigned Apgar score and neonatal race

Area of Science:

• Neonatal Medicine
• Healthcare Disparities
• Medical Bias

Background:

• The Apgar scoring system is a standard for assessing newborn health and guiding resuscitation.
• Previous evaluations have not assessed Apgar score accuracy across different racial groups.

Purpose of the Study:

• To investigate racial variations in provider-assigned Apgar scores, independent of clinical data.
• To determine if race influences Apgar scores after controlling for gestational age, umbilical cord gases, and maternal-fetal complications.

Main Methods:

• Retrospective cohort study of live births (≥23 weeks gestation) from 2019-2019.
• Analysis of electronic medical records including race, gestational age, umbilical cord gases, and Apgar scores (1 and 5 minutes).
• Ordinal regression models were used to control for clinical and demographic factors.

Main Results:

• Black neonates received significantly lower Apgar scores at 1 and 5 minutes compared to non-Black neonates, even after controlling for clinical factors.
• Lower assigned color Apgar scores contributed to the disparity in Apgar scores for Black neonates.
• Black neonates experienced higher rates of neonatal intensive care unit admission, not supported by umbilical cord gas values.

Conclusions:

• Apgar scores assigned to Black neonates appear inaccurate, as they do not align with umbilical cord gas values.
• Racial bias and colorism among healthcare providers may contribute to these scoring inaccuracies.
• Disparities in Apgar scoring may lead to unnecessary neonatal intensive care unit admissions for Black infants.