Outcomes of infants with Apgar score of zero at 10 min: the West Australian experience.

Background: Infants who have an Apgar score of zero at 10 min of age are known to have poor long-term prognosis. Expert committee guidelines suggest that it is reasonable to cease resuscitation efforts if the asphyxiated infant does not demonstrate a heart beat by 10 min of life. These guidelines are based on data from the era when therapeutic hypothermia was not the standard of care for hypoxic ischaemic encephalopathy (HIE). Hence, we aimed to review our unit data from the era of therapeutic hypothermia to evaluate the outcomes of infants who had an Apgar score of zero at 10 min and had survived to reach the neonatal intensive care unit.

Methods: Retrospective chart review.

Study Period: 2007-2013.

Results: 13 infants (gestational age ≥35 weeks) with Apgar scores of zero at 10 min were admitted to the neonatal intensive care unit. All were born outside the tertiary perinatal centre. Of them, eight died before discharge. The type and duration of follow-up varied. Of the five survivors, three had normal cognitive scores (100, 100 and 110) on Bayley III assessment at 2 years of age and one had normal Griffiths score (general quotient (GQ) 103) at 1 year. Only one infant developed severe spastic quadriplegia.

Conclusions: 4 out of 13 (30.7%) infants with 10 min Apgar scores of zero who survived to reach the neonatal intensive care unit had normal scores on formal developmental assessments. Information from large databases (preferably population based) is necessary to review recommendations regarding stopping delivery room resuscitation in term infants.