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. 2018 Feb 7:360:k207.
doi: 10.1136/bmj.k207.

Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden

Martina Persson  1 , Neda Razaz  2 , Kristina Tedroff  3 , K S Joseph  4 , Sven Cnattingius  2
Affiliations

Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden

Martina Persson et al. BMJ. .

Abstract

Objective: To investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks.

Design, setting, and participants: Population based cohort study in Sweden, including 1 213 470 non-malformed live singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries.

Exposures: Apgar scores at five and 10 minutes.

Main outcome measure: Cerebral palsy and epilepsy diagnosed up to 16 years of age. Adjusted hazard ratios were calculated, along with 95% confidence intervals.

Results: 1221 (0.1%) children were diagnosed as having cerebral palsy and 3975 (0.3%) as having epilepsy. Compared with children with an Apgar score of 10 at five minutes, the adjusted hazard ratio for cerebral palsy increased steadily with decreasing Apgar score: from 1.9 (95% confidence interval 1.6 to 2.2) for an Apgar score of 9 to 277.7 (154.4 to 499.5) for an Apgar score of 0. Similar and even stronger associations were obtained between Apgar scores at 10 minutes and cerebral palsy. Associations between Apgar scores and epilepsy were less pronounced, but increased hazard ratios were noted in infants with a five minute Apgar score of 7 or less and a 10 minute Apgar score of 8 or less. Compared with infants with an Apgar of 9-10 at both five and 10 minutes, hazard ratios of cerebral palsy and epilepsy were higher among infants with a five minute Apgar score of 7-8 and a 10 minute Apgar score of 9-10.

Conclusion: Risks of cerebral palsy and epilepsy are inversely associated with five minute and 10 minute Apgar scores across the entire range of Apgar scores.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work other than that described above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Apgar score at five and 10 minutes and hazard ratios for cerebral palsy among singleton term live births in Sweden 1999˗2012. *Total number of years each child contributed to study. †From multivariable Cox regression models adjusting for maternal factors (smoking, age at child’s birth, education, country of birth) and birth characteristics of child (birth order, birth weight for gestational age, gestational age in days, and year of birth)
Fig 2
Fig 2
Apgar score at five and 10 minutes and hazard ratios for epilepsy among singleton term live births in Sweden 1999˗2012. *Total number of years each child contributed to study. †From multivariable Cox regression models adjusting for maternal factors (smoking, age at child’s birth, education, country of birth, diagnoses of epilepsy) and birth characteristics of child (birth order, birth weight for gestational age, gestational age in days, and year of birth)
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References

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