Factors associated with low fifth minute Apgar score in term and preterm singleton live births in a Ghanaian hospital

Abstract Background: Apgar score remains the most effective measure of newborn health outcomes in the first few minutes of delivery and it is useful in diagnosing perinatal asphyxia and metabolic acidosis. Methods: This retrospective cross-sectional study was conducted at the Baptist Medical Centre in the North East Region of Ghana. For the period January 1 to December 31 2018, we extracted information on 3011 women who delivered at the facility from birth records. Binary logistic regression models were used to determine the factors associated with low fifth minute Apgar score, preterm low fifth minute Apgar score, and term low fifth minute Apgar score.Results :Nearly half of the participants had experienced 2 to 5 pregnancies (47.1%) and had given birth to 2 to 5 children (47.7%). Most of the women delivered at 37 weeks gestation or more (87.6%), attended 1 to 4 antenatal care visits (53.2%), and received 1 to 3 doses of sulfadoxine-pyrimethamine (70.9%). The majority of the newborns weighed 2.5kg or more at birth (90.7%), were delivered through the vagina (79.8%), and a little over half of them (51.40%) were males. After adjusting for potential confounders, we found evidence that multigravid women were 0.67 (95% CI 0.49 - 0.90) times less likely to deliver a child with low fifth minute Apgar score while delivery at less than 37 weeks gestation, birth weight of less than 2.5kg, and caesarean delivery were associated with increased odds of low fifth minute Apgar score. For infants born at term, being born to a multigravid mother was protective against low fifth minute Apgar score while delivery through caesarean section increased the odds of low fifth minute Apgar score among this group of newborns. Among preterm infants, our study found strong evidence that those born with low birth weight (<2.5kg) had about 4 times the odds of suffering low fifth minute Apgar score compared to those with normal birth weight.Conclusion:In designing interventions to improve the survival and the Apgar score of newborns, measures to properly diagnose and prevent preterm delivery and low birth weight should be of great concern.