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APHA Scientific Session and Event Listing

David Edward Garcia, MPH, UW Madison Population Health Fellow, City of Milwaukee Health Department, 841 North Broadway, 3rd Floor, Milwaukee, WI 53202, 414.286.2050, dgarci@milwaukee.gov, Capri-Mara Fillmore, MD, MPH, MSc, Associate Medical Director, City of Milwaukee Health Department, 841 North Broadway, Milwaukee, WI 53202, Kathleen Blair, RN, MBA, Epidemiologist, City of Milwaukee Health Department, 841 North Broadway, Milwaukee, WI 53202, and Vivian T. Chen, MSW ScD, Health Operations Director, City of Milwaukee Health Department, 841 N. Broadway, 3rd Floor, Milwaukee, WI 53202.

Infant mortality is of high concern for the City of Milwaukee Health Department, where the City's infant mortality rate (IMR) in 2004 was 11.9. Milwaukee's greatest challenge is to better understand the risk factors that contribute to the high IMR. To reduce the IMR an analysis of potential risk factors was conducted. Apgar scores are used to determine the infant's health status at birth. Relative risk analysis was made by calculating the association between Apgar scores and deaths after birth hospital discharges from City of Milwaukee birth-death link data between 1993-2003. Five minute Apgar scores were significantly and linearly related to deaths after hospital discharge. This stepwise response for five minute Apgar where scores that were greater or equal to 9 serve as the referent were: scores 8 RR=1.6 (95%CI=1.2-2.1), scores 7 RR=1.8 (95%CI=1.1-3.1), scores 6 RR=2.3 (95%CI=1.2-4.7), scores 5 RR=4.0 (95%CI=1.7-9.8), scores less than or equal to 4 RR=7.2 (95%CI=4.0-12.9). Controlling for premature births, very low birthweight or being in the NICU only diminished the association slightly but the linear relationship remained. Distribution of the causes of death were similar regardless of Apgar score, except a higher percentage of those with low Apgars died of congenital anomalies. The Apgar test done at one minute did not show as strong an association: Apgars less than or equal to 4 were only 2.5 times more apt to die after birth hospital discharge than those with 9 and 10 scores. Apgar scores can be useful potential indicators for determining IMR.

Learning Objectives:

• 1)Define the APGAR test done on infants after birth.
• 2)Recognize the importance of analyzing potential risk factors that contribute to infant mortality after birth hospital discharge.
• 3)Identify the stepwise response from 5 minute Apgar scores on infant deaths in Milwaukee after hospital discharge.

Keywords: Infant Mortality, Indicators

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 31715.8 kb)