388 - Do Apgar Scores Predict Outcomes Among Extremely Preterm Infants?

Publication Number: 388.4326

Kulsajan S. Bhatia, University of Alabama School of Medicine, Bimringham, AL, United States; ALEXANDER KUO, Uab, Birmingham, AL, United States; Maya Ahmadieh, Childrens Hospital of Alabama Warehouse, Birmingham, AL, United States; Claire E. Johnson, University of Alabama School of Medicine, Homewood, AL, United States; Vivek Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Waldemar Carlo, UAB School of Medicine, Birmingham, AL, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Colm P. Travers, UAB, Birmingham, AL, United States

Background: The Apgar score assesses and describes neonatal status after birth at set time points. The Apgar score evaluates five criteria: heart rate, respiration, muscle tone, reflexes, and color. Low Apgar scores are associated with adverse infant outcomes, including mortality. However, the utility of the Apgar score among extremely preterm infants is unclear.

Objective: The aim of this study was to determine if Apgar scores predict severe intracranial hemorrhage (ICH) or death within 7 days among extremely preterm infants.

Design/Methods: We included actively treated extremely preterm infants (22 0/7 to 27 6/7 weeks’ gestation) inborn at the University of Alabama at Birmingham regional neonatal intensive care unit from July 2017- Dec 2021. The primary outcome was grade 3-4 ICH or death within the first week after birth. Predictor variables included 1-minute and 5-minute Apgar scores (total and individual components), arterial cord pH, cord bicarbonate, first postnatal pH, and first postnatal bicarbonate. We used binary and ordinal logistic regression to determine the association between predictor variables and outcomes. Receiver operating curves (ROC) were generated to assess the performance of predictor variables based on the area under the curve (AUC) for the prediction of adverse outcomes.

Results: We included 357 actively treated extremely preterm infants of whom 54 (15.1%) had severe ICH or died in the first week. There was no association between Apgar scores (total or individual components at 1 minute and 5 minutes after birth) and severe ICH or death. The AUC-ROC for the prediction of severe ICH or death ranged from 0.39-0.52 (Figure 1). Apgar scores (total or individual components) did not predict mortality alone or severe ICH alone. Cord pH and bicarbonate and first postnatal pH and bicarbonate were also poor predictors of severe ICH or death (Table 1). Cord arterial pH and cord arterial bicarbonate were associated with color at 1 minute and heart rate at 5 minutes (all p< 0.05) but the correlations were weak (all r < 0.25). Total Apgar scores at 1 and 5 minutes respectively also did not predict mortality before discharge or major morbidities including BPD, late-onset sepsis, NEC, and spontaneous intestinal perforation (Table 2).

Conclusion(s): These findings suggest that neither Apgar scores at 1 and 5 minutes nor early blood gas measures predict severe ICH or death in extremely preterm infants. Apgar scores and initial infant status may not predict adverse outcomes in this vulnerable population.

Figure 1: Receiver operating curves for the prediction of severe ICH or death among extremely preterm infants using Apgar scores and 1 minute and 5 minutes.
Figure 1: Receiver operating curves for the prediction of severe ICH or death among extremely preterm infants using Apgar scores and 1 minute and 5 minutes.

Area under the receiver operating curves for the prediction of severe ICH or death among extremely preterm extremely preterm infants using blood gas values from arterial umbilical cord and first postnatal blood gas.
Table 1: The area under the receiver operating curves for the prediction of severe ICH or death among extremely preterm infants using blood gas values from the arterial umbilical cord and first postnatal blood gas.

Table 2: Area under the receiver operating curves for the prediction of individual outcomes using cumulative APGAR scores at 1 and 5 minutes respectively.
Table 2: Area under the receiver operating curves for the prediction of individual outcomes using cumulative APGAR scores at 1 and 5 minutes respectively.