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

INTRODUCTION: The Apgar score is a standardized method of assessing the primary adaptation and clinical status of a neonate after birth. Our objective was to systematically review and meta-analyze the survival and the survival without moderate-to-severe neurodevelopmental impairment (NDI) of neonates with a 10-min Apgar score of zero. METHODS: Six electronic databases were searched for reports published until November 2021 of neonates with a 10-min Apgar score of zero. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case series/reports. Meta-analyses of the proportion of outcomes were conducted using a random-effects model for studies published after year 2000 and reporting >5 neonates. Meta-regression using the median year of the study period and subgroup analyses by treatment with therapeutic hypothermia and by gestational age were conducted. RESULTS: Twenty-eight studies of 820 neonates with moderate risk of bias were included. Survival was 40% (95% confidence interval 30-50%, 16 studies, 646 neonates, I2 = 83%), and it increased by 2.3% per year (95% CI 1.3-3.2%, p < 0.001). Survival without moderate-to-severe NDI was 19% (95% confidence interval 11-27%, 13 studies, 211 neonates, I2 = 62%). Survival was higher for neonates who received therapeutic hypothermia and for those with a gestational age ≥32 weeks compared to <32 weeks. CONCLUSION: Approximately 2 in 5 neonates with a 10-min Apgar score of zero survived, and 1 in 5 survive without moderate-to-severe NDI survived. Survival has improved over the years, especially since the era of therapeutic hypothermia.

Neonates with a 10-min Apgar score of zero: Outcomes by gestational age.

BACKGROUND: The current resuscitation guidelines for neonates recommend considering stopping resuscitation efforts if the heart rate remains undetectable after 10 min of adequate resuscitation. However, this recommendation does not take into account the gestational age (GA) of the neonates. We determined the outcomes of neonates with a 10-min Apgar score of zero (Apgar10 = 0) with respect to their GA. METHODS: In a retrospective matched cohort study, we studied neonates admitted to the Canadian Neonatal Network NICUs between 2010 and 2016 with an Apgar10 = 0. The neonates were divided into 3 subgroups according to their GA: (1) ≥36 weeks', (2) 320/7-356/7 weeks', and (3) <32 weeks'. Each neonate with Apgar10 = 0 was matched 1:1 with neonates of same GA and sex but Apgar10 = 1-2 and Apgar10 = 3-5. Survival and brain injury were compared between matched groups. RESULTS: 177 neonates had Apgar10 = 0. Survival to discharge was significantly different between GA groups [≥36 weeks' 61% vs. 320/7-356/7 weeks' 58% vs. <32 weeks' 35%, p = 0.04]. Survival to discharge was similar to their matched cohort with Apgar10 = 1-2 for neonates born at ≥36 weeks' (61% vs. 66%) and between 320/7 to 356/7 weeks' (58% vs. 54%), but significantly different for neonates <32 weeks (35% vs. 61%, p = 0.04). CONCLUSION: Neonates with Apgar10 = 0 had different outcomes depending on their GA. Less than half of neonates born at <32 weeks GA survived; however, a majority of neonates born at 320/7-356/7 weeks' and ≥36 weeks' GA survived at similar rates than their matched neonates with Apgar10 = 1-2.