• O Genzel-Boroviczény, J Hempelman, L Zoppelli, and A Martinez.
• Department of Gynecology and Obstetrics, University Children's Hospital, University of Munich, IS, Munich, Germany. genzel@med.uni-muenchen.de
• Acta Paediatr. 2010 Dec 1;99(12):1790-4.

Aim  Is a 1-min Apgar score ≤1 predictive of mortality in resuscitated extremely premature infants?Methods A retrospective case-control review of all infants with gestational ages < 27 weeks over a 5-year period. All values as median [75% CI].Results Of 237 infants, 29 had 1-min Apgar scores ≤1 (Group 1) and 208 had scores >1 (Group 2). Despite earlier and more frequent intubation (2 min [2.3; 6.7] vs. 5 min [7.5; 10] and 93% vs. 77%, p = 0.04), mortality was higher in Group 1 (62% vs. 17%; p < 0.0001). Age at death did not differ (Group 1: 3.5days [1; 30] vs. Group 2: 6 days [6; 44]). Birth weight and sex were the best predictors of survival. With a 1-min Apgar score of 1, a male infant at 23 weeks and 500g had a mortality rate of 92%.Conclusion  Despite successful resuscitation, infants between 23 and 26 weeks have a very poor prognosis for survival when presenting with bradycardia, cyanosis and no respiratory efforts (1-min Apgar = 1) at birth. According to our data, initiating active treatment for an infant at 23 weeks with bradycardia and apnoea is almost always unsuccessful, whereas by 26 weeks gestation, the chance of survival is higher than the probability of death.© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

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