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Poster Session 2

Category: Intrapartum Fetal Assessment

Poster Session 2

(681) Neonatal acidemia and severe neonatal outcomes among term births according to Apgar score

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author(s)

MB

Martina Benuzzi, MD

Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Modena, Emilia-Romagna, Italy

Coauthor(s)

GS

Grace Spencer, BS, MS

Eastern Virginia Medical School at Old Dominion University
EVMS OBGYN, Virginia Health Sciences at Old Dominion University, Virginia, United States

Presenting Author(s)

Tetsuya Kawakita, MD, MS

Associate professor
EVMS Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA, United States
Norfolk, Virginia, United States

Objective:
A normal Apgar score does not exclude neonatal acidemia, which is linked to serious morbidity. We evaluated the association between umbilical arterial acidemia at birth and severe neonatal outcomes, stratified by 5‑minute Apgar score.

Study Design:
We performed a secondary analysis of two multicenter cohorts (Assessment of Perinatal Excellence [APEX] and Consortium on Safe Labor [CSL]). We included term neonates (≥37 weeks) with both 5‑minute Apgar scores and umbilical arterial pH (UApH). Acidemia was defined a priori as UApH < 7.10; an abnormal Apgar score as < 7 at 5 minutes. Neonates were categorized into four groups: (1) normal Apgar/no acidemia, (2) acidemia only, (3) abnormal Apgar only, and (4) both abnormal Apgar and acidemia. The primary outcome was a composite of severe neonatal outcomes (neonatal death, seizures, or suspected hypoxic‑ischemic encephalopathy [HIE]). We used modified Poisson regression with robust variance to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs), adjusting for maternal age, body mass index, chronic hypertension, preeclampsia, pregestational diabetes, and a dataset‑level random effect.

Results:
Among 51,014 term births, 47,790 (93.7%) had normal Apgar/no acidemia, 519 (1.0%) had acidemia only, 2,403 (4.7%) had abnormal Apgar only, and 302 (0.6%) had both. Maternal demographic and clinical characteristics differed across groups (Table 1). Compared with normal Apgar/no acidemia, risk of the severe composite increased stepwise: abnormal Apgar+acidemia (13.9%; aRR 221.11, 95% CI 133.84–365.28), acidemia only (3.5%; aRR 54.15, 95% CI 29.24–100.27), and abnormal Apgar only (0.7%; aRR 11.62, 95% CI 6.28–21.53) (Table 2). Component outcomes showed parallel patterns; however, several estimates were imprecise because events were rare.

Conclusion:
Umbilical arterial acidemia at birth is a strong, independent predictor of severe neonatal morbidity and mortality, even when the 5‑minute Apgar score is normal. These findings support consideration of cord blood gas analysis at term delivery to inform early neonatal management.