Predictive Factors of Apgar Scores below 7 in Newborns: Can We Change the Route of Current Events?

Introduction: The Apgar score is a useful and immediate tool used in the assessment of newborns. The factors that influence its final score may be related with labor, mother or infant itself. The impact of epidural analgesia in the Apgar score is still controversial and not fully understood. One of the limitations while attributing this score is interobserver variability. Objectives: The objective of this study was to determine possible predictive risk factors of low Apgar scores at 5 minutes, namely the influence of maternal factors, labor and newborn characteristics, as well as the effect of different analgesic concentrations used in epidural analgesia. Methods: This was a cross-sectional, institutional study conducted during two consecutive years-2014 and 2015, in Centro Materno Infantil do Norte, Portugal. Anesthesiology Department database was used to collect all the relevant information. Results: 3085 deliveries were included in the study. A significant higher number of deliveries with lower Apgar scores in 2015 compared to 2014 were noticed; furthermore a similar result was found when a certain hospital team of obstetricians was on duty (Team 4), when compared with other similar teams. Conclusion: Statistically significant differences on the Apgar indexes were found between delivery teams. Interobserver variability on Apgar classification might explain these results. Low concentrations of local anesthetic combined with opioid in an initial moment of labor do not seem to influence Apgar scores at birth. No other factor was considered predictive of low Apgar scores.