Supplementary Material for: Relationship between Apgar Scores and Morbidity and Mortality Outcomes in Preterm Infants: A Single-Centre Cohort Study

<b><i>Introduction:</i></b> Apgar scoring in modern practice has extended beyond the original described remit by Virginia Apgar, including prognostication. Prognostic value of Apgar scoring in preterm populations is unsupported by robust evidence. <b><i>Objectives:</i></b> We aimed to identify the association between mortality or a composite mortality/major morbidity outcome in preterm infants with 1-min, 5-min, and sum 1 + 5-min Apgar scores. <b><i>Methods:</i></b> Seven-year retrospective data was analysed on neonates born &lt;32 weeks gestation in a regional neonatal centre. Co-primary outcomes were mortality and composite mortality/major morbidity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression analysis. <b><i>Results:</i></b> 394 infants were included in the analysis. In neonates born &lt;28 weeks gestation, no significant association was found between Apgar scores and the co-primary outcomes. In neonates born ≥28 weeks, low 1-min (aOR 10.452 [1.273, 85.835] for scores 4–6, 22.173 [2.666, 184.438] for scores 0–3), 5-min (4.724 [1.616, 13.806] for scores 4–6, 11.178 [1.803, 69.299] for scores 0–3), and sum 1 + 5-min Apgar scores (12.447 [2.674, 57.941] for scores 4–6, 55.960 [8.333, 375.804] for scores 0–3) were associated with significantly increased aOR of mortality. Increased aOR of composite mortality/major morbidity were also seen in neonates with moderately low (4–6) Apgar scores (aOR 3.104 [1.522, 6.328] for 1 min, 2.804 [1.406, 5.594] for 5 min, and 3.232 [1.769, 5.905] for 1 + 5 min). <b><i>Conclusions:</i></b> Apgar scoring at 1 and 5 min has limited prognostic accuracy for extremely preterm infants but is prognostic in older infants. Sum Apgar scores, a measure of initial condition and response to resuscitation, may be a better predictor of mortality than individual scores.