A study to determine the association between 5 minute APGAR Scores in term newborns and mortality neonatal encephalopathy and neurodevelopment at eight weeks postnatal age, at the University Teaching Hospital

Abstract

In 1952, Virginia Apgar devised a system of scores as a means of evaluating the physical condition of the newborn immediately after birth. The Apgar score has since been accepted for use to assess newborns in almost all labour wards worldwide. While infant mortality is reducing worldwide, neonatal morbidity is increasing. Improved resuscitation techniques have improved neonatal survival, what is not yet known is how many of these babies survive without sequelae. This study sought to validate the association between 5 minute Apgar scores and mortality, neonatal encephalopathy and adverse neurodevelopment at 8 weeks postnatal age at the University Teaching Hospital, Zambia. Methods A total of 140 study subjects, meeting the inclusion criteria and consenting parents took part in the study to determine the association between 5 minute Apgar scores in term newborns and neonatal mortality, neonatal encephalopathy and neurodevelopment at 8 weeks postnatal age. The study subjects had their 5 minute Apgar scores taken by specially retrained midwives equipped with stop watches. Neonatal encephalopathy at 6-12 hours was assessed with a clinical neurological examination by the PI. At eight weeks postnatal age, their mental and motor development was assessed by the PI with the Bayley Scale of Infant Development II. Cross-tabulations and chi-square calculations in SPSS 20.0 windows version were used to assess the relationships between the Apgar scores and mortality, encephalopathy at age 6-12 hours, mental and motor development at eight weeks. Results Very low 5 minute Apgar scores (0-3) were associated with 73.3 % (22/30, OR 30.9) neonatal mortality. Very low Apgar scores (0-3) were associated with significant (moderate to severe) encephalopathy at 6 to 12 hours of age (83.3%, OR 25.6). Infants with very low 5 minute scores were 9.2 and 8 times more likely have delayed mental (OR 9.2) and motor (OR 7.7) development respectively, at eight weeks postnatal age. v High mortality (22.1%) and high follow up loss (38.6%) in the very low Apgar group made the later part of the study not statistically significant, thus needing further larger long term research. Conclusion The results of this study underscores the evidence, as reported from other studies, that Apgar scores can be used to identify infants at increased risk of neonatal encephalopathy and death, needing greater and immediate attention. Furthermore, the study has demonstrated the ability of Apgar scores to identify children who need further neurodevelopmental follow-up.