365 - Outcomes of Neonates with a 10-minute Apgar Score of Zero: A Systematic Review and Meta-Analysis

Poster Number: 365
Publication Number: 365.132

Keira C. Kilmartin, McGill University Faculty of Medicine and Health Sciences, Hudson, PQ, Canada; Bita Khorram, Lumenus community centre, Toronto, ON, Canada; Maya Dahan, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Pia Wintermark, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Prakesh Shah, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada

Background: The Apgar score is a rapid, standardized method of assessing the clinical status of a neonate after birth. Previous guidelines have recommended cessation of resuscitation at 10-minutes of life if Apgar score remains 0 due to the perceived association with increased morbidity and mortality.

Objective: To systematically review and meta-analyze the survival and survival without severe neurodevelopmental impairment (sNDI) of neonates with a 10-minute Apgar score of zero.

Design/Methods: Six electronic databases were searched for subgroup analyses of clinical trials, cohort studies, case series, and case reports of neonates with a 10-minute Apgar score of zero and published until November 2021. Risk of bias was assessed with the Newcastle-Ottawa scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for the case series/reports. The meta-analyses of proportion of survival and survival without sNDI was conducted using random-effects model for studies reporting >5 patients and those published after 2000. Meta-regression was conducted using central year of study population included.

Results: 30 studies reporting a total of 846 neonates with a 10-minute Apgar score of zero were included in this systematic review. Pooled analyses revealed that survival was 41% (95% confidence interval 32 to 50%, 17 studies, 671 patients, I2=82%, Fig 1a) and survival without significant NDI was 19% (95% confidence interval 12 to 27%, 10 studies, 229 patients, I2=63%, Fig 2a). Meta-regression revealed that survival increased by 2.1% per year (95% CI 1.1 to 3.2%, p< 0.001; Fig 1b and survival without significant NDI increased 1.0% per year (95% CI 0% to 2.3%, p=0.11; Fig 2b); however, this was not statistically significant.Conclusion(s): Approximately 2 in 5 neonates with a 10-minute Apgar score of zero survive, and 1 in 5 survive without sNDI. Survival has improved over years which may be related to several reasons including provision of therapeutic hypothermia for near-term and term neonates with neonatal encephalopathy.
Keira Kilmartin Curriculum VitaeCV Keira Kilmartin 12022021.pdf
Figure 1b: Meta-regression of survival on year of study cohorts