Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden

Abstract

ObjectiveTo investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks.Design, setting, and participantsPopulation based cohort study in Sweden, including 1 213 470 non-malformed live singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries.ExposuresApgar scores at five and 10 minutes.Main outcome measureCerebral palsy and epilepsy diagnosed up to 16 years of age. Adjusted hazard ratios were calculated, along with 95% confidence intervals.Results1221 (0.1%) children were diagnosed as having cerebral palsy and 3975 (0.3%) as having epilepsy. Compared with children with an Apgar score of 10 at five minutes, the adjusted hazard ratio for cerebral palsy increased steadily with decreasing Apgar score: from 1.9 (95% confidence interval 1.6 to 2.2) for an Apgar score of 9 to 277.7 (154.4 to 499.5) for an Apgar score of 0. Similar and even stronger associations were obtained between Apgar scores at 10 minutes and cerebral palsy. Associations between Apgar scores and epilepsy were less pronounced, but increased hazard ratios were noted in infants with a five minute Apgar score of 7 or less and a 10 minute Apgar score of 8 or less. Compared with infants with an Apgar of 9-10 at both five and 10 minutes, hazard ratios of cerebral palsy and epilepsy were higher among infants with a five minute Apgar score of 7-8 and a 10 minute Apgar score of 9-10.ConclusionRisks of cerebral palsy and epilepsy are inversely associated with five minute and 10 minute Apgar scores across the entire range of Apgar scores.

Perinatal outcome in births after a previous cesarean section at high trial of labor rates

“…A low Apgar score at 5 minutes after delivery has been associated with a longterm health impairment. 21,23,24 In the present study, after adjustment a reduced risk of NICU transfer was observed in TOLAC compared with non-TOLAC. Most previous research appears to support the view that the risk of NICU transfer in TOLAC deliveries is not higher than in non-TOLAC.…”

“…21 A Swedish population-based study reported a 5-minute Apgar score < 7 in 1.8% of TOLAC deliveries vs 1.1% in non-TOLAC. 21,23,24 In the present study, after adjustment a reduced risk of NICU The induction rate in TOLAC in the present study was 21% (all methods). 12 Obtained in deliveries comprising maternal choice, this agrees with our findings in low-risk pregnancies.…”

Children with dyskinetic cerebral palsy are severely affected as compared to bilateral spastic cerebral palsy

“…Apgar score and the need for neonatal resuscitation was correlated to subsequent risk of CP . In our cohort, 22.7% of dyskinetic CP infants had an Apgar score below five at five minutes as compared to <0.5% in the general population . This is a considerable difference and higher than what is seen in bilateral spastic CP infants (11.2%).…”

Shared unmeasured characteristics among siblings confound the association of Apgar score with stress resilience in adolescence

“…However, whether consequences of early life exposure to stress, signalled by a low Apgar score, are associated with low stress resilience persisting until adolescence has been incompletely described. Previous studies have shown an increased risk of chronic disease in children with low Apgar scores (13)(14)(15). A low Apgar score at five minutes is likely to confer a higher risk than a correspondingly low score at one minute, as a prolonged low score is likely to signal more than just transient distress associated with delivery.…”