PREDICTING LOW APGAR SCORES OF INFANTS WEIGHING LESS-THAN 1000 GRAMS - THE EFFECT OF CORTICOSTEROIDS

Objective: To evaluate maternal and neonatal factors that predict low Apgar scores in newborns weighing less than 1000 g. Methods: From a da ta set of all live-born infants who were delivered between 1979-1991 a nd who weighed 1000 g or less, we reviewed the records of 837 neonates born at 24-28 weeks' gestation. Potential risk factors were evaluated for associations with a 1-minute Apgar score of 3 or less and a 5-min ute Apgar score of 6 or less. Analyses used chi(2) test and multiple l ogistic regression. Results: The prevalence of 1-minute Apgar scores o f 3 or less decreased from 65.9% at 24 weeks to 38.2% at 28 weeks, and the prevalence of 5-minute Apgar scores of 6 or less decreased from 8 3.3% at 24 weeks to 51.2% at 28 weeks. As the birth weight increased f rom 500-599 g to 900-1000 g, 1-minute Apgar scores of 3 or less decrea sed from 77.0% to 39.6%, and 5-minute Apgar scores of 6 or less decrea sed from 89.2% to 56.4%. Aside from gestational age and birth weight, corticosteroid use was the strongest predictor of Apgar scores above 3 at 1 minute and above 6 at 5 minutes. Male and nonvertex-presenting i nfants had an increased likelihood of low Apgar stores, as did infants with cord blood pH less than 7.05 or bicarbonate value less than 17 m Eq/L. Conclusion: Neonates at very low gestational ages and birth weig hts are more likely than larger or more mature infants to have low Apg ar scores. Males, nonvertex-presenting infants, and those who are acid otic at birth also have an increased prevalence of low scores. Infants born to mothers treated with antenatal corticosteroids are less likel y to have low Apgar scores. This finding indicates that antenatal cort icosteroids may benefit the newborn at birth, before respiratory distr ess syndrome becomes apparent.