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Arch Dis Child Fetal Neonatal Ed. Jan 2002; 86(1): F16–F21.
PMCID: PMC1721350

Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age


Objective: To examine whether the combination of a low five minute Apgar score and symptoms of neonatal encephalopathy is associated with minor impairments at school age.

Design: Population based cohort study.

Setting: Norway.

Participants: All 727 children of the cohort were born between 1983 and 1987, had normal birth weights, no congenital malformations, and no major neurological abnormalities. The cohort comprised three groups with five minute Apgar scores of 0–3, 4–6, and 7–10, and were followed from birth to 8–13 years of age by combining data from The Medical Birth Registry, questionnaires, hospital discharge summaries, and the National Insurance Scheme.

Main outcome measure: Neurodevelopmental impairments such as learning, behavioural, and minor motor difficulties.

Results: Children with a five minute Apgar score of 3 or less and signs consistent with neonatal encephalopathy had a significantly increased risk of developing minor motor impairments (odds ratio (OR) 12.8, 95% confidence interval (CI) 2.6 to 63.2), epilepsy (OR 7.0, 95% CI 1.3 to 39.2), need of extra resources in kindergarten (OR 7.0, 95% CI 1.3 to 39.2) or at school (OR 3.4, 95% CI 1.8 to 6.3), and had reduced performance in reading (OR 4.6, 95% CI 2.3 to 9.5) and mathematics (OR 3.3, 95% CI 1.5 to 7.3), compared with children with normal Apgar scores and no neonatal symptoms. They also more often had problems related to tractability, aggressivity, passivity, anxiety, academic performance, and fine motor development.

Conclusion: Children with low Apgar scores and subsequent signs of cerebral depression who do not develop cerebral palsy may still have an increased risk of developing a variety of neurodevelopmental impairments and learning difficulties.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Scott H. Outcome of very severe birth asphyxia. Arch Dis Child. 1976 Sep;51(9):712–716. [PMC free article] [PubMed]
  • Nelson KB, Ellenberg JH. Apgar scores as predictors of chronic neurologic disability. Pediatrics. 1981 Jul;68(1):36–44. [PubMed]
  • Seidman DS, Paz I, Laor A, Gale R, Stevenson DK, Danon YL. Apgar scores and cognitive performance at 17 years of age. Obstet Gynecol. 1991 Jun;77(6):875–878. [PubMed]
  • Yudkin PL, Johnson A, Clover LM, Murphy KW. Clustering of perinatal markers of birth asphyxia and outcome at age five years. Br J Obstet Gynaecol. 1994 Sep;101(9):774–781. [PubMed]
  • Nagel HT, Vandenbussche FP, Oepkes D, Jennekens-Schinkel A, Laan LA, Gravenhorst JB. Follow-up of children born with an umbilical arterial blood pH < 7. Am J Obstet Gynecol. 1995 Dec;173(6):1758–1764. [PubMed]
  • APGAR V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953 Jul-Aug;32(4):260–267. [PubMed]
  • Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976 Oct;33(10):696–705. [PubMed]
  • Nelson KB, Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. 1991 Nov;145(11):1325–1331. [PubMed]
  • Nelson KB, Ellenberg JH. The asymptomatic newborn and risk of cerebral palsy. Am J Dis Child. 1987 Dec;141(12):1333–1335. [PubMed]
  • Ellenberg JH, Nelson KB. Cluster of perinatal events identifying infants at high risk for death or disability. J Pediatr. 1988 Sep;113(3):546–552. [PubMed]
  • Leviton A, Nelson KB. Problems with definitions and classifications of newborn encephalopathy. Pediatr Neurol. 1992 Mar-Apr;8(2):85–90. [PubMed]
  • Paneth N, Stark RI. Cerebral palsy and mental retardation in relation to indicators of perinatal asphyxia. An epidemiologic overview. Am J Obstet Gynecol. 1983 Dec 15;147(8):960–966. [PubMed]
  • Aylward GP. Perinatal asphyxia: effects of biologic and environmental risks. Clin Perinatol. 1993 Jun;20(2):433–449. [PubMed]
  • Gottfried AW. Intellectual consequences of perinatal anoxia. Psychol Bull. 1973 Sep;80(3):231–242. [PubMed]
  • Robertson CM, Finer NN. Long-term follow-up of term neonates with perinatal asphyxia. Clin Perinatol. 1993 Jun;20(2):483–500. [PubMed]
  • Thomson AJ, Searle M, Russell G. Quality of survival after severe birth asphyxia. Arch Dis Child. 1977 Aug;52(8):620–626. [PMC free article] [PubMed]
  • Robertson CM, Finer NN. Educational readiness of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Dev Behav Pediatr. 1988 Oct;9(5):298–306. [PubMed]
  • Robertson CM, Finer NN, Grace MG. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term. J Pediatr. 1989 May;114(5):753–760. [PubMed]
  • Carter BS, Haverkamp AD, Merenstein GB. The definition of acute perinatal asphyxia. Clin Perinatol. 1993 Jun;20(2):287–304. [PubMed]
  • Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: A population-based study in term infants. J Pediatr. 2001 Jun;138(6):798–803. [PubMed]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Group


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