6317 Apgar score and the risk of cause-specific neonatal mortality: a population-based cohort study (2025)

Results Over the period from January 1, 2007, to December 31, 2019, a total of 677,520 infants were delivered in Scotland, with 39,676 of them born prematurely. There were 521 neonatal deaths (1.3%) in total. The predominant causes of neonatal deaths included respiratory and cardiovascular disorders (n=203, 0.5%), complications arising from low birthweight and prematurity (n=179, 0.5%), and congenital malformations (n=142, 0.4%). As gestational age increased the adjusted relative risk of neonatal death increased substantially for babies with low scores compared to those with medium or high Apgar scores (figure 1). For instance, among infants born at 22 to 24 weeks with a low Apgar score, the relative risk of neonatal death was 5.7 (95% CI 3.2–10.13, p<0.001) times greater compared to those with high Apgar scores. In contrast, for infants born at 35 or 36 weeks, the corresponding relative risk was significantly higher, exceeding 80 (95% CI 56.89–112.61, p<0.001) times. The Apgar score remained informative for extremely preterm infants and discriminated between deaths due to prematurity (RR22–24 wk 12.26 (95%CI 5.1, 29.48, p-value <0.001)) and maternal factors leading to death (RR22–24 wk 3.47 (95%CI 1.13, 10.62, p-value = 0.03)) for babies with low Apgar score compared to high. However, as gestational age increased the Apgar score became less discriminatory for specific causes of death.

References

1. The Apgar score, American College of Obstetricians and Gynecologists 2015.

2. Iliodromiti S, et al. Apgar score and the risk of cause-specific infant mortality: a population-based cohort study 2014.

3. Cnattingius S, et al. Apgar Score and Risk of Neonatal Death among Preterm Infants 2020.

4. World Health Organization. WHO’s application of the ICD-10 coding system for neonatal deaths 2016.

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