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Paediatr Perinat Epidemiol. 2017 Jul;31(4):338-345. doi: 10.1111/ppe.12368. Epub 2017 Jun 16.

Can the Apgar Score be Used for International Comparisons of Newborn Health?

Author information

1
INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France.
2
Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy.
3
Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK.
4
Institute for the Care of Mother and Child, Prague, Czech Republic.
5
Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
6
ISPUP-EPI Unit, Universidade do Porto, Porto, Portugal.
7
THL National Institute for Health and Welfare, Helsinki, Finland.
8
Department Child Health, Netherlands Organisation for Applied Scientific Research, TNO Healthy Living, Leiden, the Netherlands.
9
Faculty of Medical Sciences, Department Public Health, Anton de Kom University of Suriname, Paramaribo, Suriname.

Abstract

BACKGROUND:

The Apgar score has been shown to be predictive of neonatal mortality in clinical and population studies, but has not been used for international comparisons. We examined population-level distributions in Apgar scores and associations with neonatal mortality in Europe.

METHODS:

Aggregate data on the 5 minute Apgar score for live births and neonatal mortality rates from countries participating in the Euro-Peristat project in 2004 and 2010 were analysed. Country level associations between the Apgar score and neonatal mortality were assessed using the Spearman rank correlation coefficient.

RESULTS:

Twenty-three countries or regions provided data on Apgar at 5 minutes, covering 2 183 472 live births. Scores <7 ranged from 0.3% to 2.4% across countries in 2004 and 2010 and were correlated over time (ρ = 0.88, P < 0.01). There were large differences in healthy baby scores: scores of 10 ranged from 8.8% to 92.7% whereas scores of 9 or 10 ranged from 72.9% to 96.8%. Countries more likely to score 10 s, as opposed to 9 s, for healthy babies had lower proportions of Apgar <7 (ρ = -0.43, P = 0.04). Neonatal mortality rates were weakly correlated with Apgar score <7 (ρ = -0.06, P = 0.61), but differences over time in these two indicators were correlated (ρ =0.56, P = 0.02).

CONCLUSIONS:

Large variations in the distribution of Apgar scores likely due to national scoring practices make the Apgar score an unsuitable indicator for benchmarking newborn health across countries. However, country-level trends over time in the Apgar score may reflect real changes and merit further investigation.

KEYWORDS:

Apgar Score; health indicators; neonatal morbidity; neonatal mortality

PMID:
28621463
DOI:
10.1111/ppe.12368
[Indexed for MEDLINE]

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