Low Apgar Score and the Risk of Neonatal Acute Kidney Injury: Evidence from a Matched Retrospective Cohort Study

Document Type : Original Article

Authors

1 Department of Pediatric, Zabol University of Medical Sciences, Zabol, Iran

2 Department of Pediatrics, School of Medicine, Amir al momenin Hospital, Zabol University of Medical Science

3 Department of Community Medicine, School of Medicine, Pediatric Gastroenterology and Hepatology Research center, Amir al momenin Hospital, Zabol University of Medical

4 Department of Community Medicine, 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 analysis.
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 were 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

References

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Iranian Journal of Neonatology
Volume 17, Issue 2
April 2026
Pages 39-45

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