Mortality among infants with Apgar score 0 at 10 minutes
Introduction:
An Apgar score of 0 at 10 minutes is considered an indicator of poor prognosis and has historically influenced decisions regarding neonatal resuscitation. However, mortality estimates are largely based on small heterogeneous studies. We examined infant mortality among infants with Apgar score 0 at 10 minutes and compared mortality with that among infants with Apgar scores of 1, 2, or 3.
Methods:
This nationwide population-based cohort study included 2,638,291 singleton live births in Sweden from 1999 to 2024. Analyses included 1,608 infants born at ≥36 weeks' gestation with an Apgar score of 0 to 3 at 10 minutes after birth. The primary outcome was all-cause infant mortality. Adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression.
Results:
Of 1,608 infants, 277 had an Apgar score of 0, 327 a score of 1, 398 a score of 2, and 606 a score of 3 at 10 minutes. Among infants with Apgar score 0, 143 infants (51.6%) died within the first year. The aRRs (95% CIs) for infant mortality were 1.16 (0.98-1.37) compared with Apgar score 1, 2.48 (1.99-3.09) compared with Apgar score 2, and 2.85 (2.32-3.51) compared with Apgar score 3.
Conclusion:
Infant mortality did not differ statistically significantly between infants with Apgar scores of 0 and 1 at 10 minutes, and was higher in both groups than among infants with Apgar scores of 2 or 3. These findings are consistent with resuscitation guidelines emphasizing individualized decision-making.
