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Predictive Value of Apgar Score in Low Birth Weight and Preterm Infants

Abstract
Background: Because some research shows that the Apgar score is not accurate enough to predict neonatal outcomes, especially in preterm infants, whether to discontinue use of the full Apgar score is being debated. Method: This is a population-based cross-sectional analysis of the existing registries of all newborns admitted to the 37 neonatal units in Osaka Prefecture, Japan. The Apgar score's predictive value, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for assessing neonatal mortality at each cut-off score (from 0 to 9), were calculated by stratification of birth weights and gestational ages. Results: In low birth weight (LBW) and preterm infants, area under the curve (AUC) increases when birth weight and gestational age increase. The Apgar score at 5 minutes always has a larger AUC and bigger positive likelihood ratio than the Apgar score at 1 minute. The Apgar score AUC at 5 minutes of infants with birth weights ranging from 1 500 g to 2, 499 g infants and with gestational ages from 32 weeks to 36 weeks are 0.89 and 0.91, respectively. Conclusion: The predictive value of Apgar score is inconsistent across time and populations. In Osaka, Japan, the Apgar score at 5 minutes is a good predictor for infants with birth weight from 1 500 to 2 499 g or gestational age from 32 weeks to 36 weeks. To stratify the accuracy of the predictive value of Apgar score, gestational age is better than birth weight.

Key words
Apgar score, predictive value of test, low birth weight infant, preterm birth, infant mortality

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