The following is a summary of “Associations between provider-assigned Apgar score and neonatal race,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by Edwards, et al.

The Apgar scoring system has been a standard practice in evaluating the health of newborns and identifying the need for medical intervention, such as admission to neonatal intensive care units. Despite its long-standing use, there needed to be more knowledge of the accuracy of Apgar scores across different neonatal racial groups. For a study, researchers sought to investigate the impact of neonatal race on the provider-assigned Apgar scores independently of clinical factors and umbilical cord gas values. 

The study involved a retrospective cohort analysis of electronic medical records from an urban academic medical center. The sample included all live births from January 1, 2019, to December 31, 2019, with complete data available, at ≥23 weeks and 0 days of gestation. Data collected from the medical records included race, ethnicity, gestational age, umbilical cord gas values (umbilical artery pH and base deficit), neonatal intensive care unit admission, and maternal-fetal complications. The primary outcome measures were the neonates’ Apgar scores at 1 and 5 minutes, while the secondary outcome measures included the color Apgar score and admission to the neonatal intensive care unit. The researchers used three partially proportional ordinal regression models that gradually adjusted for more covariates to analyze the data. Model 1, the baseline model, adjusted for gestational age; Model 2 additionally, adjusted for umbilical cord gases; and Model 3 additionally adjusted for maternal medical conditions and pregnancy complications.

This study analyzed 977 neonates born at or after 23 weeks of gestation from an urban academic medical center, with 56.6% being Black. The objective was to investigate how the assigned Apgar scores of healthcare providers vary according to neonatal race while controlling for clinical factors and umbilical cord gas values. Results showed that Black neonates received significantly lower Apgar scores at both 1 minute (odds ratio 0.63; 95% CI 0.49-0.80) and 5 minutes (odds ratio 0.64; 95% CI 0.47-0.87) compared to non-Black neonates, even when umbilical artery gases, gestational age, and maternal-fetal complications were considered. 4

Additionally, Black neonates had lower assigned color Apgar scores at 1 minute (odds ratio 0.52; 95% CI 0.39-0.68). The data showed that full-term Black neonates were admitted to the neonatal intensive care unit more often than non-Black neonates (odds ratio 1.29; 95% CI 0.94-1.77), despite having normal umbilical cord gas values (mean umbilical artery pH of 7.259 for Black vs. 7.256 for non-Black neonates). The study suggested that healthcare providers’ racial biases and colorism could cause inaccurate Apgar scores and unnecessary admissions to neonatal intensive care units.

The study found that Black neonates were given lower Apgar scores by healthcare providers even when their umbilical cord gases were not abnormal. It suggested that healthcare providers may have implicit biases based on race, resulting in unnecessary admissions of Black neonates to neonatal intensive care units. The findings highlighted the presence of colorism and racial biases among healthcare providers

Reference: ajog.org/article/S0002-9378(22)00626-3/fulltext