Document Type : Original Article
Authors
1
Department of Pediatric, Zabol University of Medical Sciences, Zabol, Iran
2
Associate Professor of Clinical Toxicology, Department of Community Medicine, School of Medicine, Pediatric Gastroenterology and Hepatology Research center, Amir al momenin Hospital, Zabol University of Medical
3
Associate Professor of Pediatric Neurology, Department of Pediatrics, School of Medicine, Amir al momenin Hospital, Zabol University of Medical Science
4
Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
5
Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran
6
Student Research Committee, Zabol University of Medical Sciences, Zabol, Iran.
10.22038/ijn.2026.87157.2677
Abstract
Background:
The Apgar score is a widely used indicator for assessing newborn health immediately after birth. However, its predictive value for specific organ dysfunctions such as acute kidney injury (AKI) remains uncertain. This study aimed to evaluate the association between low 5-minute Apgar scores and the risk of AKI in neonates admitted to the neonatal intensive care unit (NICU).
Methods:
In this retrospective matched cohort study conducted between 2022 and 2024 at Amir Al-Momenin Hospital, 80 neonates (40 with Apgar <7 and 40 with Apgar ≥7) were enrolled. Neonates were matched 1:1 for gestational age and admission time. Serum creatinine was measured on days 1, 3, 5, and 7, and urine output was assessed on day 3 to diagnose AKI based on modified neonatal KDIGO criteria. Statistical analyses included the Chi-square test for categorical variables, Mann–Whitney U test for non-normally distributed continuous variables, and logistic regression
Results:
Low 5-minute Apgar scores were associated with a significantly higher incidence of AKI (20% vs. 5%, p = 0.043), with a 6.3-fold increased risk (OR = 6.29, 95% CI: 1.04–37.90, p = 0.045). Gestational age between 28–32 weeks independently increased the risk of AKI (OR = 13.84, p = 0.027). Although day 1 serum creatinine was higher in the normal Apgar group (p = 0.002), no differences were observed afterward. Male sex and vaginal delivery were more common in the low Apgar group but not associated with AKI in multivariable analysis.
Conclusion:
A 5-minute Apgar score <7 and gestational age between 28–32 weeks are significant risk factors for AKI in NICU neonates. These findings highlight the potential of using Apgar score and gestational age for early risk stratification and targeted monitoring.
Keywords: Apgar score, neonatal intensive care unit, acute kidney injury, renal function, neonates
Keywords
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