THE CORRELATION BETWEEN APGAR SCORE AND GESTATIONAL AGE WITH NEONATAL SEPSIS AND ASSOCIATED MORTALITY

Abstract

Background: Neonatal sepsis is increasingly recognized as an important global health problem that challenges neonatal survival. In 2018, sepsis caused approximately 15% of all neonatal deaths worldwide. Recent data regarding preterm birth and low Apgar score as risk factors for neonatal sepsis-related death have not been reported in Indonesia. Methods: This was a case-control study conducted in Dr.Soetomo General Hospital. A case group was obtained from medical records by a total sampling of all neonates diagnosed with neonatal sepsis in 2019, and a control group of non-neonatal sepsis cases was taken by random sampling. Chi-square test and logistic regression were used to analyze the data. Results: Statistical analysis showed a significant correlation between one and five-minute Apgar score <7 (p <0.001; OR=16.69, 95% CI 8.10 – 34.38 and p <0.001; OR=35.00, 95% CI 10.46 – 117.14, respectively) and preterm birth <37 weeks gestation (p <0.001, OR=7.78, 95% CI 4.25 – 14.26) with neonatal sepsis. The mortality rate of neonatal sepsis was 40.74%. Mortality was strongly associated with one and five-minute Apgar score 0 – 3 (p=0.047, OR=4.59, 95%CI 1.05 – 20.06 and p=0.024, OR=3.12 1.09 – 8.92 respectively), extreme preterm born <28 weeks gestation (p=0.043, OR=4.59, 95% CI 1.05 – 20.06 ) and very preterm born 28 – <32 weeks gestation (p=0.032, OR=3.12 1.09 – 8.92). Conclusion: Low Apgar score and preterm birth could make neonates more at risk of neonatal sepsis. Mortality in neonatal sepsis was significantly related with one and five-minute Apgar score 0 – 3 (severe birth asphyxia) and preterm birth <32 weeks gestation.