Emily Arnovitz, Sonia MacFarlane, Aaron Kugler, Jacques Balayla
Recovery by 10 min was common but not universal. Neonatal intensive care admission and assisted ventilation, which are recorded after the 10-min assessment, are best interpreted as concurrent severity markers. These hypothesis-generating findings suggest that serial assessment between 5 and 10 min warrants prospective evaluation.
OBJECTIVE: To evaluate factors associated with recovery by 10 min among singleton infants with a low 5-min Apgar score (0-5).
METHODS: Retrospective population-based cohort study of singleton live births in the 2024 United States natality public-use file with a 5-min Apgar score of 0-5 and valid 10-min Apgar data. Recovery was defined as a 10-min score of 7-10 and persistent low Apgar as 0-6. Multivariable logistic regression estimated adjusted associations with recovery.
RESULTS: Of 41,491 infants, 24,213 (58.4%) recovered by 10 min. Recovery occurred in 76.7% of infants scoring 4-5 at 5 min versus 33.6% of those scoring 0-3 (p < .001), and increased with gestational age and birthweight (both p < .001). In the fully adjusted model, each 1-point increase in the 5-min score (aOR 1.93, 95% CI 1.90-1.97) and each additional week of gestation (aOR 1.08, 95% CI 1.07-1.09) were associated with higher odds of recovery, whereas chorioamnionitis (aOR 0.86, 95% CI 0.77-0.96, p = .007), neonatal intensive care admission (aOR 0.57, 95% CI 0.54-0.61) and ventilation beyond 6 h (aOR 0.82, 95% CI 0.76-0.87) were associated with lower odds (all other p < .001). Maternal age, infant sex and smoking were not associated with recovery.
CONCLUSION: Recovery by 10 min was common but not universal. Neonatal intensive care admission and assisted ventilation, which are recorded after the 10-min assessment, are best interpreted as concurrent severity markers. These hypothesis-generating findings suggest that serial assessment between 5 and 10 min warrants prospective evaluation.