Unexpected Low APGAR Score in Newborn

Abstract

Background: Low 5-minute APGAR scores signal neonatal compromise and remain frequent in high-burden settings. Objective: To identify maternal, intrapartum, and neonatal factors associated with low 5-minute APGAR (<7) in a tertiary centre in PUMHS Nawab shah. Methods: We conducted a descriptive cross-sectional study of 200 live, singleton births (≥34 weeks) at PUMHS, May–November 2024. Data was captured on a structured proforma; APGARs were recorded at 1 and 5 minutes. Bivariable tests (χ²/Fisher’s exact; Mann–Whitney U) screened associations, and multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% CIs. Results: Overall, 57/200 (28.5%) newborns had a low 5-minute APGAR. Independent predictors were meconium-stained liquor (aOR≈4.9), low birth weight <2500 g (aOR≈3.0), preeclampsia/eclampsia (aOR≈2.8), maternal anaemia (aOR≈2.2), and preterm birth <37 weeks (aOR≈2.3). Emergency caesarean and general anaesthesia showed crude associations but were not significant after adjustment, suggesting confounding by indication. NICU admission was more frequent after low APGAR, though not statistically significant in this sample. Conclusions: Low 5-minute APGAR is common and strongly linked to modifiable pathways. Findings support policies to strengthen antenatal care (iron–folate, blood-pressure screening/management), reduce prematurity and growth restriction, and improve intrapartum readiness for meconium (ventilation-first resuscitation), while prioritising neuraxial anaesthesia and rapid decision-to-delivery processes. Further multicentre and implementation research should test bundled interventions and evaluate cost-effectiveness in similar contexts.

Keywords: APGAR score; neonatal outcomes; meconium-stained liquor; preeclampsia; maternal anaemia; low birth weight; prematurity; caesarean section; neonatal resuscitation; Pakistan.