Five-Minute Persistently Low Apgar Score Neonates: The Incidence and Its Risk Characteristics

Objective: To determine the incidence and risk characteristic of neonates with 5-minute persistently Apgar scores less than or equal to seven in the first and fifth minute. Materials and Methods: Retrospective case-control study was conducted between January 2014 and December 2015. Both maternal and neonatal medical records were evaluated. Inclusion criteria were singleton gravidas and delivered at gestational age of 28 weeks or more. The neonates with the Apgar score of seven or less in the first minute were included. Known cases of aneuploidy or genetic syndrome, major fetal anomaly, stillbirth, intrauterine fetal death, and incomplete record were excluded. The neonates with an Apgar score of seven or less at the first and fifth minute (LAS-5) were the study group. The neonates whose fifth minute Apgar score were higher than seven (HAS-5) were the control group. Incidence and risk characteristic of neonates with Apgar scores of seven or less in the first and fifth minute with the ones with the same score only in the first minute were measured. Results: There were 8,141 deliveries during the study period. The final analytic data included 393 neonates. The fifth minute persistently low Apgar score group was 65 neonates (16.5%). Preterm birth, difficult delivery, and non-reassuring fetal heart rate patterns (NRFHR) were independent factors (OR 4.00, 95% CI 2.18 to 7.34; OR 3.91, 95% CI 1.92 to 7.99; OR 3.14, 95% CI 1.58 to 6.21; respectively). Conclusion: The incidence of LAS-5 was 7.98 per 1,000 live births. Pregnant together with NRFHR, preterm birth, and difficult delivery should be observed closely and prepared for neonatal resuscitation. Keywords: Apgar score, NRFHR, Preterm birth, Difficult delivery Received 11 Mar 2019 | Revised 4 Jul 2019 | Accepted 9 Jul 2019