Abstract
BackgroundApgar score is used for rapid assessment of newborns. Low five-minute Apgar score has been associated with increased risk of severe neurologic outcome, but data on milder outcomes, particularly in the long term, are limited. We aimed to examine the association of five-minute Apgar score with prevalence of neurologic disability and with cognitive function in early adulthood.MethodsWe conducted a prevalence study among draft-liable men born in Denmark in 1978–1983 and presenting for the mandatory army evaluation in a northern Danish conscription district. We linked records of this evaluation, which includes medical exam and intelligence testing, with the conscripts' records in the Medical Birth Registry, containing perinatal data. We examined prevalence of neurologic disability and of low cognitive function according to five-minute Apgar score.ResultsLess than 1% (136/19,559) of the conscripts had 5-minute Apgar scores <7. Prevalence of neurologic disability was 2.2% (435/19,559) overall; among conscripts with Apgar scores <7, 7–9, and 10 (reference), it was 8.8%, 2.5%, and 2.2% respectively. The corresponding prevalences of low cognitive function (intelligence test score in the bottom quartile) were 34.9%, 27.2%, and 25.0%. The outcomes were more prevalent if Apgar score <7 was accompanied by certain fetal or obstetric adversities. After accounting for perinatal characteristics, 5-mintue Apgar score <7 was associated with prevalence ratios of 4.02 (95% confidence interval: 2.24; 7.24) for neurologic disability and 1.33 (0.94; 1.88) for low cognitive function.ConclusionA five-minute Apgar score <7 has a consistent association with prevalence of neurologic disability and with low cognitive function in early adulthood.
Highlights
Apgar score is used for rapid assessment of newborns
Antenatal [3,4] and peripartum [5] adversities associated with fiveminute Apgar scores below 7 [6,7,8] have been implicated in neonatal brain injury, which in turn may lead to neurodevelopmental disability [9,10,11,12,13]
We examined whether any association of Apgar score with the study outcomes could be explained by characteristics that are risk factors for both low Apgar score and for neurodevelopmental disability [9,10,11,12,13]
Summary
Low five-minute Apgar score has been associated with increased risk of severe neurologic outcome, but data on milder outcomes, in the long term, are limited. We aimed to examine the association of fiveminute Apgar score with prevalence of neurologic disability and with cognitive function in early adulthood. Odd et al, in a large study of Swedish conscripts, reported that worse cognitive performance was related to taking a longer time to achieve an Apgar score >6 [20]. This finding was in contrast to an earlier study by Seidman et al, who found little association between Apgar score and cognitive function among Israeli draftees [21]. In addition to cognitive function, we examined prevalence of neurologic diseases, some of which are grounds for exemption from the military service
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