Abstract
Limited data are available on early childhood outcome of infants with Apgar scores assigned at 10 minutes of age. Based on observational data of the outcome of infants with an Apgar score of 0 at 10 minutes, the International Liaison Committee on Resuscitation recommended stopping resuscitation if there are no signs of life after 10 minutes of continuous and adequate resuscitation.The aim of this observational study was to determine whether Apgar scores at 10 minutes were independently associated with death or disability at 18 to 22 months of age for term infants after perinatal encephalopathy of hypoxic-ischemic origin. The investigators reassessed early childhood outcomes data on infants with low Apgar scores at 10 minutes of age in the National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial. The study subjects were infants born at ≥36 weeksʼ gestation had biochemical and/or clinical abnormalities at birth followed by demonstration of moderate or severe encephalopathy at <6 hours. The associations between the Apgar score at 10 minutes and the primary outcome of death and disability (moderate or severe) at 18 to 22 months were determined using logistic regression and classification and regression-tree analysis, with and without adjustment for covariates.Of total, 89% of the infants had Apgar scores of 0 to 2 at 1 minute, and Apgar scores at 5 and 10 minutes shifted to progressively higher values; Apgar scores of 0 to 2 at 10 minutes were found in 27% of the infants. Each point decrease in Apgar score at 10 minutes was associated with a 45% increase in the adjusted odds of death or disability. The outcomes of infants with an Apgar score of 0, 1, or 2 at 10 minutes were similar (rates of death or disability of 76%, 82%, and 80%, respectively). Classification and regression-tree analysis showed that Apgar scores at 10 minutes were predictive for outcomes of death and disability.The findings indicate that Apgar scores at 10 minutes of age may provide useful prognostic information before the availability of other evaluations. However, because death or disability is not a given even when the 10-minute Apgar is zero, the investigators suggest that these data raise concern regarding the International Liaison Committee on Resuscitation recommendation to consider discontinuing resuscitation of infants with an Apgar score of 0 at 10 minutes.