PREDICTING NEONATAL MORBIDITY AND LENGTH OF STAY USING THE APGAR SCORE: A RETROSPECTIVE COHORT STUDY

Background: Apgar score is one of the most widely used methods for assessing the health of newborns at birth. However, its potential for predicting short-term infant outcomes in resource-limited settings requires further exploration.
Objective: To assess the predictability of Apgar scores at 1 and 5 minutes on the need for assisted ventilation, length of stay in the NICU, and early neonatal death in a tertiary care NICU.
Methods: A historical observational cohort study was conducted in the Neonatology Unit of Prince Rashid Bin Al-Hassan Hospital, Jordan. The study population included live-born infants consecutively admitted to the NICU during a seven-month period from October 2025 to April 2026. Data were abstracted from the medical records using a standardized case report form. The primary exposure was the 5-minute Apgar score as low (<7) or normal (≥7), and the 1-minute Apgar score was also evaluated. Primary outcomes were need for mechanical ventilation, NICU length of stay >7 days, and hospital death within 7 days of birth. Multivariable logistic regression was adjusted for gestational age, birth weight, sex, and mode of delivery.
Results: The study included 108 newborns in total. The mean gestational age was 36.4 weeks and the mean birth weight was 2779.6 g. Thirty babies had a low 1 minute Apgar score (<7) and 9 babies had a low 5 minute Apgar score (<7). A low 5-minute Apgar score was significantly associated with increased length of stay (55.6% vs 24.2%, p=0.04). Low 1-minute Apgar scores were strongly associated with mechanical ventilation (50.0% vs 11.5%, p<0.001), length of stay (53.3% vs 16.7%, p<0.001), and death (6.7% vs 0%, p=0.03). Low 1-minute Apgar score was associated with higher risk of assisted breathing (aOR: 18.6, 95% CI: 5.2–66.7, p<0.001) and longer length of stay (aOR: 5.2, 95% CI: 1.8–15.2, p=0.002). Gestational age <34 weeks was also correlated with increased LOS (aOR: 8.6, 95% CI: 2.5–29.8, p<0.001) and artificial breathing (aOR: 12.4, 95% CI: 3.1–49.8, p<0.001).
Conclusion: 1 minute Apgar score is a good independent predictor for the need of artificial respiration and prolonged stay in NICU. The 5-minute Apgar score can also be used to predict outcomes, but the 1-minute Apgar appears to be superior for early risk stratification. These results demonstrate that the Apgar score remains a simple, bedside tool for predicting short-term neonatal outcomes in resource-limited settings.