The 5-minute Apgar Score as a Prognostic Factor for Development and Progression of Retinopathy of Prematurity

Vasil G. Marinov 1 , Desislava N. Koleva-Georgieva 1 , Nelly P. Sivkova 1  and Maya B. Krasteva 2
  • 1 Department of Ophthalmology, Faculty of Medicine, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
  • 2 Department of Obstetrics and Gynecology, Neonatology Unit, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria


Background: A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP).

Aim: To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP.

Materials and methods: The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic significance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA - spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ2 or Fisher’s exact test were used in the statistical analysis. Logistic regression was performed to find significant and independent risk factors for manifestation and progression of ROP.

Results: A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically significant risk factors of ROP (р=0.191, р=0.191, respectively), but were significant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively).

Conclusion: An Apgar score at 5 minutes of 6 or less was a significant and independent risk factor for progression of ROP to stages requiring treatment.

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