EXPRESS: Prediction of survival in neonatal kittens using APGAR and reflex scoring

The APGAR score systematically evaluates key physiological parameters to identify vulnerable neonates. APGAR assesses heart rate, respiratory rate and pattern, muscle tone, reflex irritability, and mucous membrane colour, with a low score indicating the need for intervention. In kittens, pre-weaning mortality rate is unacceptably high (approximately 15.8%1), underscoring the need for early vitality assessments. Few studies have evaluated the predictive value of APGAR scoring in kittens. This study aimed to assess potential predictions of survival in newborn kittens.

Forty kittens from 11 litters (litter size range 3-6) were assessed within 12 hours of birth. APGAR score and three neonatal reflexes (rooting, suckling strength, and positional righting) were assessed. In addition, blood lactate levels, weight, SpO₂, and temperature were also recorded.

Mortality rate was 8/40 (20%) within 4 weeks. In a Cox proportional hazards model, APGAR and reflex scores were significantly associated with survival outcomes (Hazard Ratio (HR) = 0.52, P = 0.004; HR = 0.44, P = 0.004, respectively), indicating that a one-point increase in score was associated with reduced hazard of death. Furthermore, APGAR and reflex scores were significantly associated (P = 0.001). Higher SpO₂ was protective (HR = 0.93, P = 0.006), whereas temperature (HR = 0.66, P = 0.058) and birth weight (HR = 0.96, P = 0.089) showed nonsignificant associations. Larger litter size was associated with lower APGAR scores, reduced temperature, and lower birth weight. Time to examination did not influence the predictive scores (APGAR or reflex), although temperature increased with time from birth (P = 0.009).

These findings indicate that APGAR and reflex scores are strong predictors of survival in kittens.