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Apgar scores at 10 min and outcomes at 6–7 years following hypoxic-ischaemic encephalopathy
  1. Girija Natarajan1,
  2. Seetha Shankaran1,
  3. Abbot R Laptook2,
  4. Athina Pappas1,
  5. Carla M Bann3,
  6. Scott A McDonald3,
  7. Abhik Das4,
  8. Rosemary D Higgins5,
  9. Susan R Hintz6,
  10. Betty R Vohr2,
  11. for the Extended Hypothermia Subcommittee of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
  1. 1Department of Pediatrics, Wayne State University, Detroit, Michigan, USA
  2. 2Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island, USA
  3. 3Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA
  4. 4Social, Statistical and Environmental Sciences Unit, Rockville, Maryland, USA
  5. 5Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
  6. 6Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr Girija Natarajan, Division of Neonatology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA; gnatara{at}


Aim To determine the association between 10 min Apgar scores and 6–7-year outcomes in children with perinatal hypoxic-ischaemic encephalopathy (HIE) enrolled in the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) whole body cooling randomised controlled trial (RCT).

Methods Evaluations at 6–7 years included the Wechsler Preschool and Primary Scale of Intelligence III or Wechsler Intelligence Scale for Children IV and Gross Motor Functional Classification Scale. Primary outcome was death/moderate or severe disability. Logistic regression was used to examine the association between 10 min Apgar scores and outcomes after adjusting for birth weight, gestational age, gender, outborn status, hypothermia treatment and centre.

Results In the study cohort (n=174), 64/85 (75%) of those with 10 min Apgar score of 0–3 had death/disability compared with 40/89 (45%) of those with scores >3. Each point increase in 10 min Apgar scores was associated with a significantly lower adjusted risk of death/disability, death, death/IQ <70, death/cerebral palsy (CP) and disability, IQ<70 and CP among survivors (all p<0.05). Among the 24 children with a 10 min Apgar score of 0, five (20.8%) survived without disability. The risk-adjusted probabilities of death/disability were significantly lower in cooled infants with Apgar scores of 0–3; there was no significant interaction between cooling and Apgar scores (p=0.26).

Conclusions Among children with perinatal HIE enrolled in the NICHD cooling RCT, 10 min Apgar scores were significantly associated with school-age outcomes. A fifth of infants with 10 min Apgar score of 0 survived without disability to school age, suggesting the need for caution in limiting resuscitation to a specified duration.

  • Outcomes research
  • hypoxic-ischemic encephalopathy
  • apgar scores

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