Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts on healthcare systems worldwide, particularly regarding the care of pregnant women and their neonates. The use of the Apgar score—a discrete numerical index used to evaluate neonatal condition immediately following delivery that has been used ubiquitously as a clinical indicator of neonatal condition and widely reported in the literature for decades—has continued during the pandemic. Although health systems adopted protocols that addressed pregnant women and their neonates during the pandemic, limited research has assessed the validity of Apgar scores for determining neonatal conditions in the context of COVID-19. Therefore, this scoping review was conducted on the first 2 years of the pandemic and included mothers with reverse transcription-polymerase chain reaction confirmed COVID-19 and their resulting positive or negative neonates. In total, 1,966 articles were assessed for eligibility, yielding 246 articles describing 663 neonates. Neonates who tested negative had median Apgar scores of 9 and 9 at 1 and 5 mins, respectively, while test-positive neonates had median Apgar scores of 8 and 9 at the same time points. The proportions of test-negative neonates with Apgar scores below 7 were 29 (4%) and 11 (2%) at 1 and 5 mins, which was not statistically significant (p = 0.327, χ2 = 0.961). These proportions were even lower for positive neonates: 22 (3%) and 11 (2%) at 1 and 5 mins, respectively, which was not statistically significant (p = 1, χ2 = 0). The low proportion of Apgar scores below 7 suggests that low Apgar scores are likely to be associated with severe maternal COVID-19 symptoms during delivery rather than neonatal COVID-19. Therefore, this study indicated that Apgar scores are poor indicators of neonatal COVID-19 status.
Highlights
Beginning in December 2019, the prolific spread of the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for coronavirus disease 2019 (COVID-19), resulted in the World Health Organization declaring it a pandemic on March 11, 2020 [1].As international rates of cases and death tolls continued to rise alarmingly, health systems were forced to adopt new protocols or adapt existing practices to protect vulnerable groups from the Neonatal SARS-CoV-2 Apgar Scores virus
Despite many asymptomatic pregnancies reported in the literature, many articles have suggested that severe maternal symptoms prompting Cesarean section delivery may be a cause of low Apgar score in neonates [18,19,20,21,22]
One study implicated maternal SARS-CoV-2 infection as the major cause for placental damage and low Apgar score in neonates [21]. Another common explanation for low Apgar score is preterm birth due to maternal COVID-19 complications, which results in developmentally premature neonates with lower well-being [23]
Summary
As international rates of cases and death tolls continued to rise alarmingly, health systems were forced to adopt new protocols or adapt existing practices to protect vulnerable groups from the Neonatal SARS-CoV-2 Apgar Scores virus. One such vulnerable group is neonates, born to mothers with COVID-19, whose developing immune systems may not be equipped to fight off SARS-CoV-2 infection [2]. Apgar scores above 7 are considered “reassuring,” while scores between 4 and 6 are “below normal,” and scores of 1–3 are “critically low” and typically require urgent clinical intervention [4,5,6] Due to their ease of application, Apgar scores were ubiquitously implemented to assess neonatal asphyxia without the need for blood gas analyses [4]
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