Abstract
Background: The Apgar score has been shown to be predictive of neonatal mortality in clinical and population studies, but has not been used for international comparisons. We examined population-level distributions in Apgar scores and associations with neonatal mortality in Europe.
Methods: Aggregate data on the 5 minute Apgar score for live births and neonatal mortality rates from countries participating in the Euro-Peristat project in 2004 and 2010 were analysed. Country level associations between the Apgar score and neonatal mortality were assessed using the Spearman rank correlation coefficient.
Results: Twenty-three countries or regions provided data on Apgar at 5 minutes, covering 2 183 472 live births. Scores < 7 ranged from 0.3% to 2.4% across countries in 2004 and 2010 and were correlated over time (rho = 0.88, P < 0.01).
There were large differences in healthy baby scores: scores of 10 ranged from 8.8% to 92.7% whereas scores of 9 or 10 ranged from 72.9% to 96.8%. Countries more likely to score 10 s, as opposed to 9 s, for healthy babies had lower proportions of Apgar < 7 (rho = -0.43, P = 0.04).
Neonatal mortality rates were weakly correlated with Apgar score < 7 (rho = -0.06, P = 0.61), but differences over time in these two indicators were correlated (rho = 0.56, P = 0.02). Conclusions: Large variations in the distribution of Apgar scores likely due to national scoring practices make the Apgar score an unsuitable indicator for benchmarking newborn health across countries.
However, country-level trends over time in the Apgar score may reflect real changes and merit further investigation.