The relationship between the five-minute Apgar score, mode of birth and neonatal outcomes

To investigate the relationship between the five-minute Apgar score categories (low, intermediate, and normal), mode of birth and neonatal outcomes.This was a retrospective cross sectional study of term singleton deliveries at Mater Mothers' Hospital in Brisbane, Australia between January 2007 and December 2015. The five\ua0minute score was subdivided in to three categories - low (0-3), intermediate (4-6), and normal (≥7). These were correlated with adverse neonatal outcomes and mode of birth. The referent cohort was the normal Apgar group.The study cohort consisted of 39,258 births with a recorded five\ua0minute Apgar score. Of these, 38,705 (98.6%) neonates had a normal (≥7) Apgar score, 439 (1.1%) had an intermediate score (4-6) and 114 (0.3%) had a low (0-3) score. Neonatal complications including respiratory distress, feeding problems, hypothermia, and seizures were all significantly associated with both low and intermediate Apgar scores. Emergency operative birth (caesarean and instrumental) conveyed a higher risk of low and intermediate scores and poorer neonatal outcomes.Low and intermediate five\ua0minute Apgar scores were strongly associated with mode of birth and poorer neonatal outcomes