Original Articles
The association of Apgar score with subsequent death and cerebral palsy: A population-based study in term infants,☆☆

https://doi.org/10.1067/mpd.2001.114694Get rights and content

Abstract

Objective: To estimate the risk of adverse outcomes for newborns with a low Apgar score. Study design: Population-based cohort study. All 235,165 children born between 1983 and 1987 in Norway with a birth weight of at least 2500 g and no registered birth defects were followed up from birth to age 8 to 12 years by linkage of 3 national registries. Outcomes were death and cerebral palsy (CP). Results: Five-minute Apgar scores of 0 to 3 were recorded for 0.1%, and scores of 4 to 6 were recorded for 0.6% of the children. Compared with children who had 5-minute Apgar scores of 7 to 10, children who had scores of 0 to 3 had a 386-fold increased risk for neonatal death (95% CI: 270-552) and an 81-fold (48-138) increased risk for CP. If Apgar scores at both 1 and 5 minutes were 0 to 3, the risks for neonatal death and CP were increased 642-fold (442-934) and 145-fold (85-248), respectively, compared with scores of 7 to 10. Conclusion: The strong association of low Apgar scores with death and CP in this population with a low occurrence of low scores shows that the Apgar score remains important for the early identification of infants at increased risk for serious and fatal conditions. (J Pediatr 2001;138:798-803)

Section snippets

Methods

All children born from 1983 through 1987, a total of 259,804 births, were identified in the Medical Birth Registry of Norway. The Registry records information available at the maternity units on all births with a gestational age of 16 completed weeks or more and contains data on maternal health, the delivery, and the health of the newborn including Apgar scores at 1 and 5 minutes after birth. Ascertainment of all births is ensured through record linkage with the Central Population Register run

Results

Only 0.1% of our cohort had a 5-minute Apgar score between 0 and 3, and 0.6% had a score of 4 to 6 (Table I).Infants with a 5-minute Apgar score of 0 to 3 had neonatal and infant mortality rates of 16.4% and 19.2%, respectively. Between 1 and 8 years of age, 3.0% of the children with a 5-minute Apgar score of 0 to 3 died. Among children surviving beyond 1 year of age with a 5-minute Apgar score of 0 to 3, 6.8% were receiving benefits because of CP by the age of 8 to 12 years (Table I). Rates

Discussion

In this national cohort study, children were followed up from birth until the age of 8 to 12 years by linking data from national registries with compulsory notification. The data were validated against hospital discharge summaries and information obtained from parents. Low Apgar scores at 5 minutes were convincingly associated with subsequent death or CP, and this association was even stronger if the scores at both 1 and 5 minutes were low. Children with Apgar scores of 3 or less at both 1 and

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  • Cited by (0)

    Supported by a grant from the Norwegian Research Council.

    ☆☆

    Reprint requests: Dag Moster, MD, Department of Pediatrics, Barneklinikken, N-5021 Bergen, Norway.

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