Use and Implications of the Apgar score in Evaluating Resuscitation of Newborns with Birth Asphyxia in Ghana

Objective To evaluate lack of impact of Helping Babies Breathe Program on neonatal mortality in four Ghana hospitals despite quality improvement measures. Methods Analyzed correlations between Apgar scores and outcome in newborns ≥ 34 weeks gestation who had birth asphyxia (BA, 1 minute Apgar score < 7) and severe BA (1 minute Apgar score ≤ 3). Results Among 12,702 live births, 18.9% had BA and 2.8% had severe BA. Among 2044 newborns with 1 minute Apgar score of 4–6, 16 (0.8%) died, compared to 15.6% mortality in 352 newborns with severe BA (p < 0.0001). In newborns with severe BA, the mortality rate was higher in those whose scores remained ≤ 3, than in those whose scores rose to 4–6 or more by 5 minutes (OR 19.93, 95% CI 9.4; 42.1;p < 0.0001). Conclusions The Apgar score is helpful in understanding where additional interventions may improve BA related neonatal mortality in low and middle income countries.