Low Apgar score and need for resuscitation increased the probability of receiving therapeutic hypothermia more strongly than acidosis at birth

Acta Paediatr. 2023 Apr;112(4):667-674. doi: 10.1111/apa.16643. Epub 2023 Jan 9.


Aim: The aim of this study was to investigate how individual markers for birth asphyxia, so-called A criteria, were associated with the probability of receiving therapeutic hypothermia.

Methods: This population-based cohort study included 1336 live-born singleton term infants with any A criterion in the Stockholm-Gotland Region, Sweden during 2008 to 2014. The Swedish Neonatal Quality Register and National Patient Register were used for data collection. Results were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results: There were 89 infants, 44 boys and 45 girls with mean gestational age 40.5 weeks, who received therapeutic hypothermia. Low Apgar score, aOR 12.44 (95% CI 5.99-25.86), and resuscitation, aOR 9.18 (95% CI 3.77-22.34), were strongly associated with therapeutic hypothermia. A pH <7.0 was less associated with the outcome, aOR 2.02 (95% CI 1.02-4.0). No infant who received therapeutic hypothermia fulfilled the criteria of base deficit ≥16 mmol/L only.

Conclusion: A low Apgar score of and/or a need for resuscitation is more relevant for identifying infants eligible for therapeutic hypothermia, compared to other A criteria. This knowledge could be used clinically to identify cases for review and avoid unnecessary monitoring of infants.

Keywords: Apgar score; birth asphyxia; hypoxic-ischemic encephalopathy; neonatal resuscitation; therapeutic hypothermia.

MeSH terms

  • Acidosis* / complications
  • Apgar Score
  • Asphyxia Neonatorum* / therapy
  • Cohort Studies
  • Female
  • Humans
  • Hypothermia, Induced*
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases* / therapy
  • Male
  • Odds Ratio