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Increasing trends in a low 5-min Apgar score among (near) term singletons: a Dutch nationwide cohort study

Journal of Perinatology volume 44, pages 217–223 (2024)Cite this article

Subjects

Abstract

Objective

To investigate trends in low Apgar scores in (near) term singletons using the Dutch Perinatal Registry.

Methods

In a cohort of 1,583,188 singletons liveborn ≥35 weeks of gestation in the period 2010–2019, we studied trends in low 5-min Apgar scores (<7 and <4) using Cochrane Armitage trend tests.

Results

The proportion of infants with low Apgar scores <7 and <4 increased significantly between 2010–2019 (1.04–1.42% (p < 0.001), 0.17–0.19% (p = 0.009), respectively). Neonatal mortality remained unchanged. Induction of labour, epidural analgesia and planned caesarean section showed an increasing trend. Instrumental vaginal delivery and emergency caesarean section were performed less frequently over time, but these intervention subgroups showed the highest relative increase in infants with low Apgar scores.

Conclusions

In the Netherlands, the risk of a low 5-min Apgar score increased over the last decade. The highest relative increase was observed in subgroups of instrumental vaginal delivery and emergency caesarean section.

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Data availability

The data that support the findings of this study are available from Perined but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of Perined.

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Acknowledgements

The authors thank all Dutch midwives, obstetricians, neonatologists and other perinatal healthcare providers for the registration of perinatal information.

Author information

Authors and Affiliations

  1. Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands

    C. E. Tacke, W. Onland & F. A. M. van den Dungen

  2. Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands

    C. E. Tacke, W. Onland & F. A. M. van den Dungen

  3. Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, the Netherlands

    P. C. A. M. Bakker & A. C. J. Ravelli

  4. Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

    F. Groenendaal

  5. Perined, Utrecht, the Netherlands

    A. N. Rosman, L. Broeders, S. Koole & G. de Winter

  6. Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands

    J. V. Been & R. F. Kornelisse

  7. Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands

    J. V. Been

  8. Department of Medical Informatics, Amsterdam University Medical Centers, Amsterdam, the Netherlands

    A. C. J. Ravelli

  9. Department of Neonatology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands

    T. A. J. Antonius

  10. Division of Neonatology, department of pediatrics, Beatrix Children’s Hospital, University Medical Centre Groningen, Groningen, the Netherlands

    P. H. Dijk

  11. Department Neonatology, Maxima Medical Center, Veldhoven, the Netherlands

    K. P. Dijkman

  12. Department of Neonatal Intensive Care Unit, Isala Women and Children’s Hospital, Isala Hospital, Zwolle, the Netherlands

    F. A. B. A. Schuerman

  13. Department of Neonatology, Maastricht University Medical Center, Maastricht, the Netherlands

    E. van Westering-Kroon

  14. Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands

    R. S. G. M. Witlox

Authors
  1. C. E. Tacke
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  2. W. Onland
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  3. P. C. A. M. Bakker
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  4. F. Groenendaal
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  5. A. N. Rosman
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  6. L. Broeders
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  7. J. V. Been
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  8. A. C. J. Ravelli
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Consortia

N3 Benchmarking group

  • T. A. J. Antonius
  • , P. H. Dijk
  • , K. P. Dijkman
  • , F. A. M. van den Dungen
  • , F. Groenendaal
  • , S. Koole
  • , R. F. Kornelisse
  • , W. Onland
  • , F. A. B. A. Schuerman
  • , C. E. Tacke
  • , E. van Westering-Kroon
  • , R. S. G. M. Witlox
  •  & G. de Winter

Contributions

CT contributed to the design of the study, wrote initial draft of the manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. AR contributed to the design of the study, performed the analysis, reviewed and revised the manuscript and approved the final manuscript as submitted. WO, PB, FG, AR, LB, and JB contributed to the design of the study, reviewed and revised the manuscript and approved the final manuscript as submitted. All members of the N3 benchmarking group contributed to the data collection and approved the final manuscript as submitted.

Corresponding author

Correspondence to C. E. Tacke.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The committee for research and ethics of Perined approved the study protocol (Perined approval 21.13). The registry contains anonymous data and takes the European privacy policy into account. Medical ethical approval and individual informed consent for participation were not necessary.

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Tacke, C.E., Onland, W., Bakker, P.C.A.M. et al. Increasing trends in a low 5-min Apgar score among (near) term singletons: a Dutch nationwide cohort study. J Perinatol 44, 217–223 (2024). https://doi.org/10.1038/s41372-023-01786-2

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