Determinants of low APGAR score in newborns delivered at Lemlem Karl general hospital, Northern Ethiopia, 2018: a case control study

Abstract BACKGROUND: The Apgar score is a method to quickly summarize the health of newborn children. It establishes a simple and clear classification of newborns, which could be used to predict survival and to compare methods of resuscitation and perinatal experience across hospitals and obstetric practices. Low Apgar score is associated with various immediate and long-term adverse health outcomes of newborns. Hence; in order to decrease the risk/complications, identifying the determinant factors of low Apgar is crucial to act on the modifiable risk factors. This study is aimed to investigate the determinant factors of a low Apgar score in newborn children.METHOD: The study was conducted in Lemelem Karl general hospital; northern Ethiopia. An institutional-based unmatched, case-control study was implemented. Data were retrieved from medical charts of 662 newborns’ mothers who gave birth in the hospital from Sep 2014 to Sep 2017. Among these, 221 of them were cases (charts of mothers whose newborns’ fifth minute Apgar score was <7) and 441 of them were controls (charts of mothers whose newborns’ Apgar score was 7 and above). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was done to determine the association and statistical significance was declared at P-value of ≤0.05. RESULTS: This study revealed that low Apgar score was significantly associated with antepartum hemorrhage [Adjusted odds ratio (AOR) 3.509; 95% confidence interval (CI) 1.526-8.067), P= 0.003], pregnancy-induced hypertensive disorders [AOR 2.69; 95% CI (1.351-5.357), P= 0.005], prolonged second stage of labor [AOR 2.63; 95% CI (1.399-4.944), P= 0.003], Cesarean delivery [AOR 2.005; 95%CI (1.223-3.287), P= 0.006],meconium-stained liquor [AOR 6.955; 95% CI (3.721-13.001), P<0.001], and low birth weight [AOR 4.38; 95% CI (2.216-8.657), P<0.001].CONCLUSION: Result from this study showed a remarkable linkage of low Apgar score with antepartum hemorrhage, pregnancy-induced hypertensive disorders, meconium-stained liquor, and low birth weight. Therefore, meticulous antenatal care and labour management service are recommended to prevent low Apgar score and the concomitant neonatal death.