Low Apgar score as a risk factor for respiratory disturbances in the newborn infant

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Abstract
The value of the Apgar score as a risk factor for all neonatal respiratory disturbances (RD) was evaluated in a prospective study of an unselected population. All liveborn infants (n = 4656) of mothers living in Gothenburg were screened over one year for signs of respiratory disease. This unselected population could be obtained since virtually all infants in Gothenburg are born in two maternity hospitals, with similar treatment principles, the same equipment standard and neonatal care. A low one minute Apgar score (< 7) was found to be a powerful risk factor for RD in full term newborns and infants of 33 - 36 weeks gestation provided that the delivery had been vaginal. In these infants a low Apgar score at five minutes further increased the risk of RD. In immature infants < 32 weeks and after cesarean section in all gestational ages a low Apgar score did not mean any additional risk of RD (table I). The respiratory component in the Apgar score was not more predictive of RD than any of the others (figure 2). In most infants with RD, irrespective of Apgar score, there was a few hours interval free from respiratory signs after birth (table III). It has been well shown in other studies that Apgar score is not a reliable index of intrauterine or birth asphyxia. Nevertheless the one-minute score is a powerful predictor of neonatal respiratory difficulties. One explanation might be that Apgar score is correlated with sympathoadrenal activity at birth. Another might be that the vitality in the period immediately after birth - reflected by the Apgar score - is crucial for the ability of the infant to expand the lungs effectively after birth. This may affect the respiratory adaptation in the postnatal period by hampering the ability to eliminate lung water, by suppressing surfactant release or by other mechanisms.