title: Correlates of birth asphyxia using two Apgar score classification methods.
abstract: BACKGROUND
  Birth asphyxia is commonly indexed by low five-minute Apgar scores especially in resource-constrained settings but the impact of different classification thresholds on the associated risk factors has not been reported.
  
  
  OBJECTIVE
  To determine the potential impact of two classification methods of five-minute Apgar score as predictor for birth asphyxia.
  
  
  METHODS
  A cross-sectional study of preterm and term survivors in Lagos, Nigeria in which antepartum and intrapartum factors associated with "very low" (0-3) or "intermediate" (4-6) five-minute Apgar scores were compared with correlates of low five-minute Apgar scores (0-6) based on multinomial and binary logistic regression analyses.
  
  
  RESULTS
  Of the 4281 mother-infant pairs enrolled, 3377 (78.9%) were full-term and 904 (21.1%) preterm. Apgar scores were very low in 99 (2.3%) and intermediate in 1115 (26.0%). Antenatal care, premature rupture of membranes (PROM), hypertensive disorders and mode of delivery were associated with very low and intermediate Apgar scores in all infants. Additionally, parity, antepartum haemorrhage and prolonged/obstructed labour (PROL) were predictive in term infants compared with maternal occupation and intrauterine growth restriction (IUGR) in preterm infants. Conversely, PROM in term infants and maternal occupation in preterm infants were not significantly associated with the composite low Apgar scores (0-6) while IUGR was associated with term infants.
  
  
  CONCLUSIONS
  Predictors of birth asphyxia in preterm and term infants are likely to be affected by the Apgar score classification method adopted and the clinical implications for optimal resuscitation practices merit attention in resource-constrained settings.
authors.affiliation: Maternal and Child Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria. boolusanya@aol.com
authors.forename: Bolajoko O
authors.initials: BO
authors.lastname: Olusanya
authors.forename: Olumuyiwa A
authors.initials: OA
authors.lastname: Solanke
mesh_terms: D000328:Adult; D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000145:classification / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009035:Mothers; D015997:Neonatal Screening / Q000379:methods*; D009549:Nigeria; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult