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Refining the Apgar score cut‐off point for newborns at risk
Author(s) -
Chong DSY,
Karlberg J
Publication year - 2004
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2004.tb00674.x
Subject(s) - medicine , apgar score , receiver operating characteristic , singleton , population , medical record , mortality rate , obstetrics , pediatrics , birth weight , gestation , false positive rate , pregnancy , statistics , mathematics , genetics , environmental health , biology
Aim : To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods : The records of all singleton live births without severe congenital malformations and length of gestation >25 wk ( n = 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results : Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%). Conclusions : Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth.