Delivery-room intervention, early neonatal outcomes and risk factors among term infants with a low 5-minute Apgar score: a case–control study in a regional Australian hospital

Delivery-room intervention, early neonatal outcomes and risk factors among term infants with a low 5-minute Apgar score: a case–control study in a regional Australian hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Delivery-room intervention, early neonatal outcomes and risk factors among term infants with a low 5-minute Apgar score: a case–control study in a regional Australian hospital Sheikh Arif Kozgar, Santosh Pathak, Reji Thomas, Prativa Dhakal, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7191544/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Objective To examine delivery-room escalation and early neonatal care requirements among term infants with compromised transition at birth, using a 5-minute Apgar score <7 as a pragmatic marker, and to identify associated maternal and intrapartum factors. Design Unmatched case–control study. Setting Regional Australian hospital. Patients Infants born at ≥37 weeks’ gestation from 2018 to 2022. Cases were infants with a 5-minute Apgar score <7 (n=91) and controls were infants with a 5-minute Apgar score ≥7 (n=91). Interventions Clinical interventions and escalation were assessed from medical records. Main outcome measures Delivery-room interventions and escalation (including emergency/code blue activation), admission to special care nursery (SCN) or transfer to tertiary care, and maternal and intrapartum factors associated with Apgar score <7 at 5 minutes. Results Among 4,344 term births, the incidence of 5-minute Apgar score <7 was 2.09%. Resuscitation was required in 91/91 (100%) cases and 37/91 (40.7%) controls; code blue activation occurred in 37/91 (40.7%) cases and 2/91 (2.2%) controls. SCN admission occurred in 74/91 (81.3%) cases; controls were more often managed on the postnatal ward (46/91, 50.5%). Transfer to a tertiary centre occurred in 6/91 (6.6%) cases. In multivariable analysis, caesarean delivery (aOR 2.60, 95% CI 1.21- 5.58), prolonged rupture of membranes (aOR 2.91, 95% CI 1.06 - 0.95) and shoulder dystocia (aOR 9.38, 95% CI 1.07- 82.54) were associated with Apgar score <7. Previous caesarean section (aOR 0.31, 95% CI 0.11- 0.87) and morphine administration prior to delivery (aOR 0.13, 95% CI 0.05- 0.38) were inversely associated. Conclusion In this regional term birth cohort, a 5-minute Apgar score <7 was associated with increased delivery-room escalation and higher likelihood of SCN admission or tertiary transfer. Health sciences/Risk factors Health sciences/Health care/Paediatrics Apgar score incidence maternal risk factors neonatal outcomes regional KPI Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7191544","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492779205,"identity":"8de5b911-9a84-4ad2-9b79-d610bd74289f","order_by":0,"name":"Sheikh Arif 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hospital\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Apgar score, incidence, maternal risk factors, neonatal outcomes, regional, KPI","lastPublishedDoi":"10.21203/rs.3.rs-7191544/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7191544/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo examine delivery-room escalation and early neonatal care requirements among term infants with compromised transition at birth, using a 5-minute Apgar score \u0026lt;7 as a pragmatic marker, and to identify associated maternal and intrapartum factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign \u003c/strong\u003eUnmatched case–control study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e Regional Australian hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e Infants born at ≥37 weeks’ gestation from 2018 to 2022. Cases were infants with a 5-minute Apgar score \u0026lt;7 (n=91) and controls were infants with a 5-minute Apgar score ≥7 (n=91).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e Clinical interventions and escalation were assessed from medical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain outcome measures\u003c/strong\u003e Delivery-room interventions and escalation (including emergency/code blue activation), admission to special care nursery (SCN) or transfer to tertiary care, and maternal and intrapartum factors associated with Apgar score \u0026lt;7 at 5 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Among 4,344 term births, the incidence of 5-minute Apgar score \u0026lt;7 was 2.09%. Resuscitation was required in 91/91 (100%) cases and 37/91 (40.7%) controls; code blue activation occurred in 37/91 (40.7%) cases and 2/91 (2.2%) controls. SCN admission occurred in 74/91 (81.3%) cases; controls were more often managed on the postnatal ward (46/91, 50.5%). Transfer to a tertiary centre occurred in 6/91 (6.6%) cases. In multivariable analysis, caesarean delivery (aOR 2.60, 95% CI 1.21- 5.58), prolonged rupture of membranes (aOR 2.91, 95% CI 1.06 - 0.95) and shoulder dystocia (aOR 9.38, 95% CI 1.07- 82.54) were associated with Apgar score \u0026lt;7. Previous caesarean section (aOR 0.31, 95% CI 0.11- 0.87) and morphine administration prior to delivery (aOR 0.13, 95% CI 0.05- 0.38) were inversely associated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e In this regional term birth cohort, a 5-minute Apgar score \u0026lt;7 was associated with increased delivery-room escalation and higher likelihood of SCN admission or tertiary transfer.\u003c/p\u003e","manuscriptTitle":"Delivery-room intervention, early neonatal outcomes and risk factors among term infants with a low 5-minute Apgar score: a case–control study in a regional Australian hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-02-25 00:18:47","doi":"10.21203/rs.3.rs-7191544/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2025-07-29 19:14:06","doi":"10.21203/rs.3.rs-7191544/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27e5edd9-c463-4e1b-8846-363a30dd01b7","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62558957,"name":"Health sciences/Risk factors"},{"id":62558958,"name":"Health sciences/Health care/Paediatrics"}],"tags":[],"updatedAt":"2025-07-29T19:14:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 00:18:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-7191544","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7191544","identity":"rs-7191544","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}