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Comparative Predictive Value of Combined Versus Conventional Apgar Scores for Mortality, Ventilation, Seizures, and Other Outcomes in Hospitalized Neonates: A Prospective Cohort Study. | ||
| Advances in Pharmacology and Therapeutics Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 30 November 2025 | ||
| Document Type: Original Article | ||
| Authors | ||
| Amir kamal Hardani1; Mohammad Reza Aramesh2; Neda Hardani3; Arash Malakian4; Gholam Reza Badfar5; Nima Bakhtiari* 6; Minoo Ahmadi7 | ||
| 1Pediatrics Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. | ||
| 2Pediatrics Department, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran | ||
| 3Pediatric Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. | ||
| 4Department of Pediatrics, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. | ||
| 5Department of Pediatrics, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. | ||
| 6Pain Research center, Ahvaz Jundishapur University of Medical sciences | ||
| 7Department of Nursing, College Midwifery and Nursing, Masjed Soleiman Medical Science, Islamic Azad University, Masjed Soleiman, Iran. | ||
| Abstract | ||
| Objective: To compare the predictive performance of the combined Apgar score versus the conventional Apgar score in forecasting adverse clinical outcomes among hospitalized neonates in a tertiary care setting. Methods: This prospective cohort study, conducted from April to October 2023 at Imam Khomeini and Sina Hospitals in Ahvaz, Iran, enrolled 637 neonates requiring hospitalization. Both conventional and combined Apgar scores were recorded at 1, 5, and 10 minutes post-birth by trained neonatologists following standardized protocols. The combined Apgar score integrated gestational age adjustments and resuscitative interventions, while the conventional score assessed five physiological parameters. Primary outcomes included mortality, need for mechanical ventilation, length of hospital stay, seizures, and blood product infusions. Predictive performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis, with Area Under the Curve (AUC) >0.75 as the threshold for acceptable sensitivity. Multivariable logistic regression adjusted for confounders such as gestational age and birth weight. Results: Of the 637 neonates (64% male, 36% female; gestational age 23–42 weeks; birth weight 500–5060 grams), 193 were preterm. The combined Apgar score demonstrated significantly higher sensitivity and specificity than the conventional score in predicting mortality (n=99), mechanical ventilation (n=166), seizures (n=51), blood product infusions (n=139), and prolonged hospital stays (all AUC >0.75, p<0.0001). Significant negative correlations were observed between Apgar scores and adverse outcomes, with the combined score showing stronger prognostic accuracy, particularly in preterm infants. Conclusion: The combined Apgar score, by incorporating gestational age and intervention data, offers superior predictive accuracy for neonatal morbidity and mortality compared to the conventional method. Its adoption in clinical practice could enhance early identification of high-risk neonates, optimize resource allocation, and improve outcomes, particularly in preterm and high-risk populations. Multicenter studies with long-term follow-up are warranted to validate and extend these findings. | ||
| Keywords | ||
| Combined Apgar score; conventional Apgar score; neonatal outcomes; ROC analysis; preterm infants | ||
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