Incidence and risk factors of low Apgar scores at five minutes in term neonates: A case control study in a Regional Australian Hospital

Abstract Objective: To assess the incidence of low Apgar scores (<7 at 5 minutes) and identify associated maternal risk factors in a regional Australian hospital. Study Design: An unmatched case-control study examined records of 4,344 infants born at ≥37 weeks from 2018 to 2022, identifying 91 cases with low Apgar scores and an equal number of controls. Logistic regression identified associated factors included in the multivariate model. Results: The incidence of low Apgar scores was 2.09%. Multivariate analysis indicated that morphine administration before delivery decreased risk (AOR 0.13, p < 0.001) and previous caesarean delivery offered protection (AOR 0.31, p = 0.026). Risk factors included prolonged rupture of membranes (AOR 2.91, p = 0.038), caesarean delivery (AOR 2.60, p = 0.014), and shoulder dystocia (AOR 9.38, p = 0.044). Conclusion: Higher rates of low Apgar scores in regional Australia highlight the importance of targeted interventions to enhance neonatal outcomes.