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Five-minute Apgar score as a marker for developmental vulnerability at 5 years of age
  1. Neda Razaz1,2,
  2. W Thomas Boyce3,
  3. Marni Brownell4,
  4. Douglas Jutte5,
  5. Helen Tremlett6,
  6. Ruth Ann Marrie7,
  7. K S Joseph1,2
  1. 1School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Departments of Pediatrics and Psychiatry, School of Medicine, University of California, San Francisco, California, USA
  4. 4Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  5. 5School of Public Health, University of California, Berkeley, California, USA
  6. 6Brain Research Centre and Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Departments of Internal Medicine and Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Neda Razaz, Women's Hospital of British Columbia, Room C403—4500 Oak Street, Vancouver, British Columbia, Canada V6H 3N1; Neda.Razaz{at}gmail.com

Abstract

Objective To assess the relationship between the 5 min Apgar score and developmental vulnerability at 5 years of age.

Design Population-based retrospective cohort study.

Setting Manitoba, Canada.

Participants All children born between 1999 and 2006 at term gestation, with a documented 5 min Apgar score.

Exposure 5 min Apgar score.

Main outcome measures Childhood development at 5 years of age, expressed as vulnerability (absent vs present) on five domains of the Early Development Instrument: physical health, social competence, emotional maturity, language and cognitive development, and communication skills.

Results Of the 33 883 children in the study, most (82%) had an Apgar score of 9; 1% of children had a score <7 and 5.6% had a score of 10. Children with Apgar scores <10 had higher odds of vulnerability on the physical domain at age 5 years compared with children with a score of 10 (eg, adjusted OR (aOR) for Apgar 9=1.23, 95% CI 1.05 to 1.44). Similarly, children with Apgar scores of <10 were more vulnerable on the emotional domain (eg, aOR for Apgar 9=1.20, 95% CI 1.03 to 1.41). Nevertheless, the Apgar-based prognostic model had a poor sensitivity for physical vulnerability (19%, 95% CI 18% to 20%). Although the Apgar score-based prognostic model had reasonable calibration ability and risk-stratification accuracy for identifying developmentally vulnerable children, classification accuracy was poor.

Conclusions The risk of developmental vulnerability at 5 years of age is inversely associated with the 5 min Apgar score across its entire range, and the score can serve as a population-level indicator of developmental risk.

  • Child Psychology
  • Comm Child Health
  • Epidemiology

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