A question often asked of medical students during their newborn nursery rotation is, “Which Apgar score is most predictive of how the baby will do?” It’s a little bit of a trick question, since most students only observe the 1- and 5-minute Apgar scores being given after delivery of a baby. The traditionally correct answer is “The 10-minute Apgar.” But is this true?
Additionally, 10-minute Apgar scores are often used as a basis for decisions about discontinuing resuscitation, based on 2015 recommendations from the American Heart Association. But is a 10-minute Apgar score sufficient to make this decision?
Dr. Vivek Shukla and colleagues in the Neonatal Research Network attempt to answer these questions. This week, Pediatrics is early releasing their article entitled, “Predictive Ability of 10-Minute Apgar Scores for Mortality and Neurodevelopmental Disability” (10.1542/peds.2021-054992).
The authors analyze 18-22 month follow-up data from a clinical trial in which newborns diagnosed with moderate/severe hypoxic-ischemic encephalopathy were randomized to receive therapeutic hypothermia or not.
Of the 307 infants who had both a documented 10-minute Apgar score and follow-up at 18-22 months, 26 had had a 10-minute Apgar score of 0.
Infants with a 10-minute Apgar score of 0 were 72% more likely to die or have moderate/severe disability, and that was statistically significant.
However, that’s not the whole story.
Of the 26 infants, 13 – so half of them – survived. Of this 13, 6 had no disability, 2 had mild disability, and 5 had moderate/severe disability. (Please read the article to see how the degree of disability was defined.)
While the 10-minute Apgar score was predictive of death or moderate/severe disability, the predictive ability was not good. The authors suggest that maybe a 15- or 20-minute Apgar score might be more helpful, or adding additional variables (for example, seizures or decerebrate posture) may add more precision to a predictive model.
This is an important article for everyone who cares for newborns to read. Remember – the 10-minute Apgar score may not be as predictive as we once thought.