Whether the change in scores between 5 to 10 minute Apgars (including among normal scores) is relevant and has any influence on risk for cerebral palsy (CP) and epilepsy
Persson et al. (BMJ 2018) investigated whether there is an association between Apgar scores at five and ten minutes and risk of childhood CP or epilepsy
Population-based cohort study
Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages
All patients received Apgar scores at 5 and 10 minutes
The primary outcome was cerebral palsy and epilepsy diagnosed up to 16 years of age
Adjusted hazard ratio (HR) was used, along with 95% confidence intervals
Data was collected from 1,213,470 live, term singleton infants without malformations
1,221(0.1%) children were diagnosed as having cerebral palsy
3,957(0.3%) were diagnosed with epilepsy
Compared with children with an Apgar score of 10 at five minutes, the adjusted HR for cerebral palsy increased steadily with decreasing Apgar score
Risk increased from 1.9 (95% CI, 1.6 to 2.2) for an Apgar score of 9 to 277.7 (95% CI, 154.4 to 499.5) for an Apgar score of 0
A similar correlation was observed to a stronger degree between Apgar scores at 10 minutes
Associations between Apgar scores and epilepsy were less pronounced
Increased HRs were noted in infants with a 5 minute Apgar score of 7 or less and a 10 minute Apgar score of 8 or less
When comparing the change between 5 and 10 minutes scores
Highest HRs were seen in offspring with a very low Apgar score at both five and 10 minutes
Increasing Apgar scores from five to 10 minutes were associated with decreasing HR of CP
Children with a score of 7-8 at both five and 10 minutes had a higher risk for CP than children with an Apgar score of 9-10 at both five and 10 minutes (HR of 5.3)
HRs for CP were also significantly higher among children with five minutes Apgar score of 9 and a 10 minute Apgar score of 10 compared with infants who had an Apgar score of 10 at both five and 10 minutes
Adjusted HR 1.3, 95% CI, 1.0 to 1.5
Risk of cerebral palsy and epilepsy are inversely related to Apgar score
The authors suggest that
[t]he finding that children with five minute Apgar scores of 7-8 and 10 minute Apgar scores of 7-8 have higher hazard ratios of cerebral palsy and epilepsy (hazard ratios were 5.3 and 1.5, respectively) is concerning and warrants critical attention from the resuscitation community.
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