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BMJ Open. 2012 Aug 8;2(4). pii: e001095. doi: 10.1136/bmjopen-2012-001095. Print 2012.

The 5-minute Apgar score as a predictor of childhood cancer: a population-based cohort study in five million children.

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1
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.

Abstract

OBJECTIVE:

The aetiology of childhood cancer remains largely unknown but recent research indicates that uterine environment plays an important role. We aimed to examine the association between the Apgar score at 5 min after birth and the risk of childhood cancer.

DESIGN:

Nationwide population-based cohort study.

SETTING:

Nationwide register data in Denmark and Sweden.

STUDY POPULATION:

All live-born singletons born in Denmark from 1978 to 2006 (N=1 771 615) and in Sweden from 1973 to 2006 (N=3 319 573). Children were followed up from birth to 14 years of age.

MAIN OUTCOME MEASURES:

Rates and HRs for all childhood cancers and for specific childhood cancers.

RESULTS:

A total of 8087 children received a cancer diagnosis (1.6 per 1000). Compared to children with a 5-min Apgar score of 9-10, children with a score of 0-5 had a 46% higher risk of cancer (adjusted HR 1.46, 95% CI 1.15 to 1.89). The potential effect of low Apgar score on overall cancer risk was mostly confined to children diagnosed before 6 months of age. Children with an Apgar score of 0-5 had higher risks for several specific childhood cancers including Wilms' tumour (HR 4.33, 95% CI 2.42 to 7.73).

CONCLUSIONS:

A low 5 min Apgar score was associated with a higher risk of childhood cancers diagnosed shortly after birth. Our data suggest that environmental factors operating before or during delivery may play a role on the development of several specific childhood cancers.

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