Predictive value of the 1-min Apgar score for survival at 23–26 weeks gestational age
Article first published online: 29 OCT 2010
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Pædiatrica
Volume 99, Issue 12, pages 1790–1794, December 2010
How to Cite
Genzel-Boroviczény, O., Hempelman, J., Zoppelli, L. and Martinez, A. (2010), Predictive value of the 1-min Apgar score for survival at 23–26 weeks gestational age. Acta Paediatrica, 99: 1790–1794. doi: 10.1111/j.1651-2227.2010.01937.x
- Issue published online: 29 OCT 2010
- Article first published online: 29 OCT 2010
- Received 24 January 2010; revised 28 June 2010; accepted 29 June 2010.
- Apgar score;
Aim: Is a 1-min Apgar score ≤1 predictive of mortality in resuscitated extremely premature infants?
Methods: A retrospective case–control review of all infants with gestational ages <27 weeks over a 5-year period. All values as median [75% CI].
Results: Of 237 infants, 29 had 1-min Apgar scores ≤1 (Group 1) and 208 had scores >1 (Group 2). Despite earlier and more frequent intubation (2 min [2.3; 6.7] vs. 5 min [7.5; 10] and 93% vs. 77%, p = 0.04), mortality was higher in Group 1 (62% vs. 17%; p < 0.0001). Age at death did not differ (Group 1: 3.5 days [1; 30] vs. Group 2: 6 days [6; 44]). Birth weight and sex were the best predictors of survival. With a 1-min Apgar score of 1, a male infant at 23 weeks and 500 g had a mortality rate of 92%.
Conclusion: Despite successful resuscitation, infants between 23 and 26 weeks have a very poor prognosis for survival when presenting with bradycardia, cyanosis and no respiratory efforts (1-min Apgar = 1) at birth. According to our data, initiating active treatment for an infant at 23 weeks with bradycardia and apnoea is almost always unsuccessful, whereas by 26 weeks gestation, the chance of survival is higher than the probability of death.