Apgar-Scores, Duration of Pregnancy, Birth Weight, and Somatic Classification of Neonates 17th Communication: An Analysis of Newborns From Eight German Federal States Born between 1998 and 2000

Abstract

Aim: We aimed to examine the impact of duration of pregnancy, birth weight, and the somatic classification of neonates - small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA) - on rates of neonatal depression, as demonstrated by low Apgar scores (0-3). Methods: We analysed data from 508 926 singleton births in the years 1998-2000 from the perinatal statistics of eight German federal states (Bavaria, Brandenburg, Hamburg, Mecklenburg-West Pomerania, Lower Saxony, Saxony, Saxony-An-halt, and Thuringia). For the somatic classification of neonates the 10th and 90th birth weight percentiles calculated from our dataset were used. We defined neonates with a birth weight Under the 10th percentile as SGA, those between the 10th and 90th birth weight percentiles as AGA, and those above the 90th percentile as LGA. Results: A low Apgar score (0-3) was observed in 37.3% of very early preterm infants (< 27 weeks' gestation) at 5 minutes and in 34.4% at 10 minutes. For term neonates, such low Apgar-scores were seen in only 0.2% (5-minute Apgar) and 0.1% (10-minute Apgar). An Apgar score of 0-3 was noted for 31.8% (5 minutes) and 29.2% (10 minutes) of extremely small neonates (< 999 g). Only 0.1% of neonates with a birth weight of 3500-3999 g or 4000-4499 g had a low Apgar score (0-3) (after both 5 and 10 minutes). Very early preterm infants classified as SGA or AGA were equally affected by low Apgar scores: 37.2% for both categories at 5 minutes, and 32.7% (SGA) and 34.3%(AGA) at 10 minutes. In very early preterm LGA infants the rates with low Apgar Scores were somewhat smaller: 31.3% (5 minutes) and 27.0% (10 minutes). The figures for early preterm (27-31 weeks' gestation) infants were: a low 5-minute Apgar score in 25.5% of cases (SGA), in 9.1% (AGA), and in 7.8% (LGA) and a low 10-minute Apgar score in 24.4% (SGA), 7.7% (AGA), and 7.0% (LGA). Conclusions: We confirm the association of low Apgar scores with preterm birth and low birth weight. SGA preterm infants are more commonly affected by low Apgar scores compared to AGA and especially LGA preterm infants.