Recovery after low five-minute Apgar score: Predictors of ten-minute improvement in U.S. natality data

To evaluate factors associated with recovery by 10 min among singleton infants with a low 5-min Apgar score (0-5).

Retrospective population-based cohort study of singleton live births in the 2024 United States natality public-use file with a 5-min Apgar score of 0-5 and valid 10-min Apgar data. Recovery was defined as a 10-min score of 7-10 and persistent low Apgar as 0-6. Multivariable logistic regression estimated adjusted associations with recovery.

Of 41,491 infants, 24,213 (58.4%) recovered by 10 min. Recovery occurred in 76.7% of infants scoring 4-5 at 5 min versus 33.6% of those scoring 0-3 (p < .001), and increased with gestational age and birthweight (both p < .001). In the fully adjusted model, each 1-point increase in the 5-min score (aOR 1.93, 95% CI 1.90-1.97) and each additional week of gestation (aOR 1.08, 95% CI 1.07-1.09) were associated with higher odds of recovery, whereas chorioamnionitis (aOR 0.86, 95% CI 0.77-0.96, p = .007), neonatal intensive care admission (aOR 0.57, 95% CI 0.54-0.61) and ventilation beyond 6 h (aOR 0.82, 95% CI 0.76-0.87) were associated with lower odds (all other p < .001). Maternal age, infant sex and smoking were not associated with recovery.

Recovery by 10 min was common but not universal. Neonatal intensive care admission and assisted ventilation, which are recorded after the 10-min assessment, are best interpreted as concurrent severity markers. These hypothesis-generating findings suggest that serial assessment between 5 and 10 min warrants prospective evaluation.