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Arch Dis Child Fetal Neonatal Ed. 2016 Mar;101(2):F114-20. doi: 10.1136/archdischild-2015-308458. Epub 2015 Jul 17.

Five-minute Apgar score as a marker for developmental vulnerability at 5 years of age.

Author information

1
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2
Departments of Pediatrics and Psychiatry, School of Medicine, University of California, San Francisco, California, USA.
3
Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
4
School of Public Health, University of California, Berkeley, California, USA.
5
Brain Research Centre and Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
6
Departments of Internal Medicine and Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

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.

KEYWORDS:

Child Psychology; Comm Child Health; Epidemiology

PMID:
26187935
PMCID:
PMC4789716
DOI:
10.1136/archdischild-2015-308458
[Indexed for MEDLINE]
Free PMC Article

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