Prediction of survival in neonatal kittens using APGAR and reflex scoring
- 1Ross University School of Veterinary Medicine, Basseterre, St Kitts and Nevis (West Indies)
Abstract
Objectives:: The APGAR score systematically evaluates key physiological parameters to identify vulnerable neonates. APGAR assesses heart rate, respiratory rate and pattern, muscle tone, reflex irritability and mucous membrane colour, with a low score indicating the need for intervention. In kittens, the pre-weaning mortality rate is unacceptably high (approximately 15.8%1), underscoring the need for early vitality assessments. Few studies have evaluated the predictive value of APGAR scoring in kittens. This study aimed to assess potential predictions of survival in newborn kittens.
Methods:: A total of 40 kittens from 11 litters (litter size range 3–6) were assessed within 12 h of birth. APGAR score and three neonatal reflexes (rooting, suckling strength and positional righting) were assessed. In addition, blood lactate levels, weight, oxygen saturation (SpO2) and temperature were also recorded.
Results:: Mortality rate was 8/40 (20%) within 4 weeks. In a Cox proportional hazards model, APGAR and reflex scores were significantly associated with survival outcomes (hazard ratio (HR) 0.52, P = 0.004; HR 0.44, P = 0.004, respectively), indicating that a 1-point increase in score was associated with reduced hazard of death. Furthermore, APGAR and reflex scores were significantly associated (P = 0.001). Higher SpO2 was protective (HR 0.93, P = 0.006), whereas temperature (HR 0.66, P = 0.058) and birth weight (HR 0.96, P = 0.089) showed non-significant associations. Larger litter size was associated with lower APGAR scores, reduced temperature and lower birth weight. Time to examination did not influence the predictive scores (APGAR or reflex), although temperature increased with time from birth (P = 0.009).
Conclusions and relevance:: These findings indicate that APGAR and reflex scores are strong predictors of survival in kittens.
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BibTeX
@article{thorogood2026prediction,
title = {{Prediction of survival in neonatal kittens using APGAR and reflex scoring}},
author = {Jemma Thorogood and Pompei Bolfa and Amanda Benge and Marissa Cleary and Kerry E. Rolph},
journal = {Journal of Feline Medicine and Surgery},
year = {2026},
month = aug,
doi = {10.1177/1098612x261478823},
url = {https://doi.org/10.1177/1098612x261478823},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Prediction of survival in neonatal kittens using APGAR and reflex scoring
AU - Jemma Thorogood
AU - Pompei Bolfa
AU - Amanda Benge
AU - Marissa Cleary
AU - Kerry E. Rolph
PY - 2026
DA - 2026/08/11
JO - Journal of Feline Medicine and Surgery
DO - 10.1177/1098612x261478823
UR - https://doi.org/10.1177/1098612x261478823
AB - Objectives:: The APGAR score systematically evaluates key physiological parameters to identify vulnerable neonates. APGAR assesses heart rate, respiratory rate and pattern, muscle tone, reflex irritability and mucous membrane colour, with a low score indicating the need for intervention. In kittens, the pre-weaning mortality rate is unacceptably high (approximately 15.8%1), underscoring the need for early vitality assessments. Few studies have evaluated the predictive value of APGAR scoring in kittens. This study aimed to assess potential predictions of survival in newborn kittens. Methods:: A total of 40 kittens from 11 litters (litter size range 3–6) were assessed within 12 h of birth. APGAR score and three neonatal reflexes (rooting, suckling strength and positional righting) were assessed. In addition, blood lactate levels, weight, oxygen saturation (SpO2) and temperature were also recorded. Results:: Mortality rate was 8/40 (20%) within 4 weeks. In a Cox proportional hazards model, APGAR and reflex scores were significantly associated with survival outcomes (hazard ratio (HR) 0.52, P = 0.004; HR 0.44, P = 0.004, respectively), indicating that a 1-point increase in score was associated with reduced hazard of death. Furthermore, APGAR and reflex scores were significantly associated (P = 0.001). Higher SpO2 was protective (HR 0.93, P = 0.006), whereas temperature (HR 0.66, P = 0.058) and birth weight (HR 0.96, P = 0.089) showed non-significant associations. Larger litter size was associated with lower APGAR scores, reduced temperature and lower birth weight. Time to examination did not influence the predictive scores (APGAR or reflex), although temperature increased with time from birth (P = 0.009). Conclusions and relevance:: These findings indicate that APGAR and reflex scores are strong predictors of survival in kittens.
SN - 1098-612X
SN - 1532-2750
ER -