Low 5-Minute Apgar Score and Severe Neonatal Outcomes in Preterm Prelabor Rupture of Membranes [21O

Abstract

INTRODUCTION: The Apgar score has limited prediction accuracy of adverse outcomes. We studied the association of a low 5-minute Apgar score with severe neonatal outcomes (SNO) in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). METHODS: We conducted a secondary analysis of a prospective cohort study of singleton pregnancies with PPROM at an academic institution from October 2015 to May 2018. Fetal demise and complex anomalies were excluded. The primary exposure was Apgar <7; the primary outcome was SNO. The rate of SNO was compared in neonates with a 5-minute Apgar score <7 to those ≥7. SNO was defined as one or more of the following: RDS; necrotizing enterocolitis; grade III-IV IVH; neonatal sepsis; or neonatal death. Fischer exact test was utilized for statistical analysis. RESULTS: Of 105 pregnancies included, 89 were African American and 83 delivered ≥28 weeks gestation. SNO occurred in 42 neonates (41%). 20 newborns received a 5-minute Apgar score <7 (19%); the median gestational age at delivery was significantly less in this group (26 vs. 32 weeks, P<.001). Therefore we compared the association of 5-minute Apgar <7 and SNO after 28 weeks gestation; neonates with Apgars <7 were more likely to develop SNO than those with scores ≥7 (6 (100%) vs. 15 (18%); RR 5.1; 95% CI 3.3–8.0; P<.001). CONCLUSION: In pregnancies complicated by PPROM, a low 5-minute Apgar score may be associated with severe neonatal outcomes. We recommend our findings be corroborated in diverse populations.