Rate and determinants of low fifth minute Apgar score at the federal medical centre Yenagoa, Bayelsa State, Nigeria


  • Olakunle I. Makinde Department of Obstetrics and Gynecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria
  • Benjamin O. Awotundun Department of Obstetrics and Gynecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria
  • Nkencho Osegi Department of Obstetrics and Gynecology, Federal Medical Centre Yenagoa, Bayelsa State, Nigeria




Perinatal asphyxia, Rate, Determinants, Nigeria, Low fifth minute Apgar score


Background: About a quarter of neonatal deaths and about 10% of deaths of children under 5 years are due to intrapartum related events reflected as low fifth minute Apgar score. This study is to assess the rate of low fifth minute Apgar score and its determinants at the Federal Medical Centre Yenagoa, Bayelsa State, Nigeria.

Methods: A cross-sectional study of births at the Federal Medical Centre Yenagoa between July 2020 and April 2021. Data was collected in real time from parturients’ case notes at delivery. Low fifth minute Apgar score was defined as Apgar score < 7 at the 5th minute of birth. Data was analysed using IBM SPSS Statistics version 23. Multivariate logistic regression was used to identify determinants of low fifth minute Apgar score. P Value was 0.05.

Results: Rate of low fifth minute Apgar score was 16.6%. Unbooked status (OR - 2.29; CI-1.11 - 4.71; p value - 0.024), emergency caesarean section (OR - 10.44; CI - 1.10 - 99.26; p value - 0.041), urgent caesarean section (OR - 25.75; CI - 2.58 – 256.72; p value=0.006) and breech presentation (OR - 1.96; CI - 1.03 – 3.82; p value=0.049) significantly increased the odd of low fifth minute Apgar score.

Conclusions: Unbooked status, emergency and urgent caesarean section, and breech presentation were the determinants of low fifth minute Apgar score in the population studied. This highlights the patient group and clinical scenario requiring a focus of intervention for prevention of morbidity and mortality from low fifth minute Apgar score.


Apgar V. A Proposal for a New Method of Evaluation of the Newborn Infant. Anesth Analg. 2015;120(5):1056-9.

Apgar V, Holiday DA, James LS, Weisbrot IM, Berrien C. Evaluation of the newborn infant; second report. J Am Med Assoc. 1958;168(15):1985-8.

Apgar V, James LS. Further observation on the newborn scoring system. Am J Dis Child. 1962;104(4):419-28.

American College of Obstetricians and Gynecologists, American Academy of Pediatrics. The Apgar score. Committee opinion No. 644. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;126:e52-55.

American Academy of Pediatrics and American Heart Association. Textbook of Neonatal Resuscitation. 6th edition. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2011.

American College of Obstetrics and Gynecology, Task Force on Neonatal Encephalopathy; American Academy of Pediatrics. Neonatal Encephalopathy and Neurologic Outcome, 2nd edition. Washington, DC: American College of Obstetricians and Gynecologists; 2014.

Jeganathan R, Karalasingam SD, Hussein J, Allotey P, Reidpath DD. Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010-2012. BMC Preg Childb. 2017;17:110.

Aliyu I, Lawal T O, Onankpa B. Hypoxic-Ischemic-Encephalopathy and the Apgar scoring system: The experience in a resource-limited setting. J Clin Sci. 2018;15(1):18-20.

Bayih WA, Tezera TG, Alemu AY, Belay DM, Hailemeskel HS, Ayalew MY. Prevalence and determinants of asphyxia neonatorum among live births at Debre Tabor General Hospital, North Central Ethiopia: a cross-sectional study. Afr Health Sci. 2021;21(1):385-96.

UNICEF. UNICEF DATA: Neonatal mortality, 2023. Available at: https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed 22 April 2023.

UNICEF. UNICEF DATA: Newborn care, 2022. Available at: https://data.unicef.org/topic/maternal-health/newborn-care/. Accessed 22 April 2023.

Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and Ten minutes Apgar scores and risks of cerebral palsy and epilepsy: a population based cohort study in Sweden. BMJ. 2018;360:k207.

Ehrenstein V. Association of Apgar scores with death and neurologic disability. Clin Epidemiol. 2009;1:45-53.

Stuart A, Otterblad Olausson P, Källen K. Apgar scores at 5 minutes after birth in relation to school performance at 16 years of age. Obstet Gynecol. 2011;118(2 Pt 1):201-8.

Gillette E, Boardman JP, Calvert C, John J, Stock SJ. Associations between low Apgar scores and mortality by race in the United States: A cohort study of 6,809,653 infants. PLoS Med. 2022;19(7):e1004040.

Junior LCM, Pinto CN, Gerencer CS, Pro ECG, de Carvalho HB. Association of maternal, fetal and labor variables with a low Apgar score in the fifth minute in term pregnancy: a case-control study. Arch Gynecol Obstet. 2022;1-11.

Chiclla MAC, Atencio, Castillo KEA, Arias JPS. Perinatal low fifth-minute Apgar predictors at a Peruvian hospital. Rev Fac Med Hum. 2021;21(1):40-9.

Getachew B, Etefa T, Asefa A, Terefe B, Dereje D. Determinants of Low Fifth Minute Apgar Score among Newborn Delivered in Jimma University Medical Center, Southwest Ethiopia. Int J Pediatr. 2020;2020:9896127.

Zewude SB, Ajebe TM, Gessesse SS, Wassie TH. Proportion and Predictive factors of low Apgar score at five minute among singleton term neonates delivered in Debre Tabor Specialized hospital, Northwest Ethiopia: A cross-sectional study. Int J Afr Nurs Sci. 2021;15:100322.

Mersha A, Shibiru S, Bante A. Meconium-stained liquor and low birth weight increases the odds of low fifth-minute apgar scores in public health facilities of arba minch town, southern Ethiopia: a cross-sectional study. J Pediatr Neonatal Care. 2020;10(3):86-90.

Wayessa Z, Belachew T, Joseph J. Birth asphyxia and associated factors among newborns delivered in jimma zone public hospitals, Southwest Ethiopia: a cross-sectional study. J Midwifery Reprod Health. 2018;6(2):1289-95.

Gudayu TW. Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. Afr Health Sci. 2017;17(1):1-6.

Admasu FT, Melese BD, Amare TJ, Zewude EA, Denku CY, Dejenie TA. The magnitude of neonatal asphyxia and its associated factors among newborns in public hospitals of North Gondar Zone, Northwest Ethiopia: A cross-sectional study. PLoS ONE. 2022;17(3):e0264816.

Jamie AH, Abdosh MZ. Prevalence and risk factors of perinatal asphyxia in a tertiary care level hospital, Harari Regional State, Ethiopia. J Nepal Paediatr Soc. 2019;39(2):103-8.

Workineh Y, Semachew A, Ayalew E, Animaw W, Tirfie M, Birhanu M. Prevalence of perinatal asphyxia in East and Central Africa: systematic review and meta-analysis. Heliyon. 2020;6(4):e03793.

Dassah ET, Odoi AT, Opoku BK. Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: a retrospective cross-sectional analysis. BMC Pregnancy Childbirth. 2014;14:289.

Ugwu GI, Abedi HO, Ugwu EN. Incidence of birth asphyxia as seen in central hospital and GN children's clinic both in Warri Niger Delta of Nigeria: an eight year retrospective review. Glob J Health Sci. 2012;4(5):140-6.

Omokhodion FO, Roberts OA, Onadeko MO, Beach JR, Cherry N, Burstyn I. Social, obstetric and environmental determinants of low Apgar score among infants born in four selected hospitals in Ibadan, Nigeria. J Obstet Gynaecol. 2018;38(4):454-60.

Idris UA. Perinatal asphyxia in term neonates seen in Federal Medical Centre, Birnin Kudu, Nigeria. Int J Health Allied Sci. 2019;8:44-7.

Yelamali B, Panigatti P, Pol R, Talawar K, Naik S, Badakali A. Outcome of newborn with birth asphyxia in tertiary care hospital-a retrospective study. Medica Innovatica. 2014;3(2):59-64.

Trotman H, Garbutt A. Predictors of outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies. J Trop Pediatr. 2010;57(1):40-44.

Yadav S, Shah GS, Poudel P, Mishra OP. Risk factors for adverse outcome in asphyxiated newborn in Eastern Nepal. Int J Comm Med Pub Heal. 2017;3(6):1419-23.

Agrawal J, Yadav S, Chaudhary S, Kafle S. Treatment and outcome of neonates with hypoxic ischaemic encephalopathy at BP Koirala Institute of Health Sciences. Sri Lanka J Child Heal. 2017;46(2).

Seyal T, Hanif A. Factors related to adverse outcome in asphyxiated babies. Ann King Edw Med Univ. 2009;15(4):180-0.

Adebami OJ. Maternal and fetal determinants of mortality in babies with birth asphyxia at Osogbo, Southwestern Nigeria. Glo Adv Res J Med Med Sci. 2015;4(6):270-6.

Padayachee N, Ballot DE. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. SAJCH S Afr J Child Health. 2013;7(3):89-94.

Ekwochi U, Asinobi NI, Osuorah CD, Ndu IK, Ifediora C, Amadi OF, et al. Incidence and Predictors of Mortality Among Newborns with Perinatal Asphyxia: A 4-Year Prospective Study of Newborns Delivered in Health Care Facilities in Enugu, South-East Nigeria. Clin Med Insights Pediatr. 2017;11:1179556517746646.

Yitayew YA, Yalew ZM. Survival status and predictors of mortality among asphyxiated neonates admitted to the NICU of Dessie comprehensive specialized hospital, Amhara region, Northeast Ethiopia. PLoS ONE. 2022;17(12):e0279451.

Ketema DB, Aragaw FM, Wagnew F, Mekonnen M, Mengist A, Alamneh AA, et al. Birth asphyxia related mortality in Northwest Ethiopia: A multi-centre cohort study. PLoS ONE. 2023;18(2):e0281656.

Kawakami MD, Sanudo A, Teixeira MLP, Andreoni S, de Castro JQX, Waldvogel B, et al. Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country. BMC Pregnancy Childbirth. 2021;21:169.

Mu Y, Li M, Zhu J, Wang Y, Xing A, Liu Z, et al. Apgar score and neonatal mortality in China: an observational study from a national surveillance system. BMC Pregnancy Childbirth. 2021;21:47.

Abukari AS, Awuni N, Yakubu I, Mohammed S, Yakubu A, Yakubu S. Factors associated with low fifth minute Apgar score in term and preterm singleton live births in a Ghanaian hospital. J Neonatal Nurs. 2021;27(6):476-82.

Yeshaneh A, Kassa A, Kassa ZY, Adane D, Fikadu Y, Wassie ST, et al. The determinants of 5th minute low Apgar score among newborns who delivered at public hospitals in Hawassa City, South Ethiopia. BMC Pediatr. 2021;21(1):266.

Tavares VB, E Souza JS, Affonso MVG, Da Rocha EM, Rodrigues LFG, da Costa Moraes LF, et al. Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study. BMC Pediatr. 2022;22(1):560.

Ajibo BD, Wolka E, Aseffa A, Nugusu MA, Adem AO, Mamo M, et al. Determinants of low fifth minute Apgar score among newborns delivered by cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: an unmatched case control study. BMC Pregnancy Childbirth. 2022;22(1):665.

Lai S, Flatley C, Kumar S. Perinatal risk factors for low and moderate five-minute Apgar scores at term. Eur J Obstet Gynecol Reprod Biol. 2017;210:251-6.

Bayelsa State. Website of the Bayelsa State government, 2022. Available at: https://bayelsastate.gov.ng/. Accessed on 28 April 2023.






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