title: Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010-2012.
abstract: The neonatal Apgar score at 5 min has been found to be a better predictor of outcomes than the Apgar score at 1 min. A baby, however, must pass through the first minute of life to reach the fifth. There has been no research looking at predictors of recovery (Apgar scores ≥7) by 5 min in neonates with 1 min Apgar scores <4.
  
  
  
  An analysis of observational data was conducted using live, singleton, term births recorded in the Malaysian National Obstetrics Registry between 2010 and 2012. A total of 272,472 live, singleton, term births without congential anomalies were recorded, of which 1,580 (0.59%) had 1 min Apgar scores <4. Descriptive methods and bi- and multi-variable logistic regression were used to identify risk factors associated with recovery (5 min Apgar score ≥7) from 1 min Apgar scores <4.
  
  
  
  Less than 1% of births have a 1 min Apgar scores <4. Only 29.4% of neonates with 1 min Apgar scores <4 recover to a 5 min Apgar score ≥7. Among uncomplicated vaginal deliveries, after controlling for other factors, deliveries by a doctor of neonates with a 1 min Apgar score <4 had odds of recovery 2.4 times greater than deliveries of neonates with a 1 min Apgar score <4 by a nurse-midwife. Among deliveries of neonates with a 1 min Apgar score <4 by doctors, after controlling for other factors, planned and unplanned CS was associated with better odds of recovery than uncomplicated vaginal deliveries. Recovery was also associated with maternal obesity, and there was some ethnic variation - in the adjusted analysis indigenous (Orang Asal) Malaysians had lower odds of recovery.
  
  
  
  A 1 min Apgar score <4 is relatively rare, and less than a third recover by five minutes. In those newborns the qualification of the person performing the delivery and the type of delivery are independent predictors of recovery as is maternal BMI and ethnicity. These are associations only, not necessarily causes, and they point to potential areas of research into health systems factors in the labour room, as well as possible biological and cultural factors.
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, Ministry of Health Malaysia, Johor Bahru, Malaysia.
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Jeganathan
authors.affiliation: National Obstetric Registry, Clinical Research Centre, Ministry of Health Malaysia, Kualar Lumpur, Malaysia.
authors.forename: Shamala D
authors.initials: SD
authors.lastname: Karalasingam
authors.affiliation: Immpact, University of Aberdeen, Aberdeen, Scotland, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Hussein
authors.affiliation: South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia.|Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 46150, Malaysia.
authors.forename: Pascale
authors.initials: P
authors.lastname: Allotey
authors.affiliation: South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia. daniel.reidpath@monash.edu.|Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 46150, Malaysia. daniel.reidpath@monash.edu.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Reidpath
mesh_terms: D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008296:Malaysia / Q000453:epidemiology; D009721:Nurse Midwives / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology*; D009774:Obstetrics; D010820:Physicians / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012042:Registries; D012307:Risk Factors; D047929:Term Birth
keywords: Apgar score; Malaysia; Newborn; Registries; Term birth