Apgar Score at 5 Minutes Is Associated with Mortality in Extremely Preterm Infants Even after Transfer to an All Referral NICU

Am J Perinatol. 2015 Nov;32(13):1268-72. doi: 10.1055/s-0035-1554803. Epub 2015 Jun 9.


Objective: The Apgar score has been shown to have utility in predicting mortality in the extremely preterm infant in delivery hospital populations, where most mortality occurs within 12 hours of birth. We tested the hypothesis that the 5 minute Apgar score would remain associated with mortality in extremely preterm infants after transfer from the delivery hospital to an all referral neonatal intensive care unit at an average age of 10 days.

Study design: A retrospective analysis of 454 infants born at < 27 weeks gestation.

Results: The median Apgar score was 3 at 1 minute (interquartile range [IQR] 2-6) and 6 at 5 minutes (IQR 4-7). The Apgar score increased from 1 to 5 minutes by 2.0 ± 1.7 (p < 0.001). In logistic regression modeling, an Apgar score of < 5 at 5 minutes was associated with an increased mortality (odds ratio 1.76 [95% confidence interval 1.06-2.94], p < 0.05), but not morbidities.

Conclusion: Infants born at < 27 weeks gestation admitted to an all referral children's hospital at a mean age of 10 days with a 5 minute Apgar < 5 are at an increased risk of mortality. Our findings continue to support the importance of the Apgar score given at delivery even in the extremely preterm infant referred to a nondelivery children's hospital.

MeSH terms

  • Apgar Score*
  • Cerebral Ventricles
  • Cohort Studies
  • Ductus Arteriosus, Patent / epidemiology
  • Enterocolitis, Necrotizing / epidemiology
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Extremely Low Birth Weight
  • Infant, Extremely Premature
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Intracranial Hemorrhages / epidemiology
  • Logistic Models
  • Male
  • Odds Ratio
  • Patient Transfer
  • Prognosis
  • Referral and Consultation
  • Retrospective Studies