The Association of Apgar Score With Subsequent Death and Cerebral Palsy: A Population-Based Study in Term Infants

Today, fewer newborn children in Norway have low Apgar scores than was formerly the case, but it is not clear whether improved obstetrical practices will affect the score's predictive value. This population-based cohort study estimated the risk of adverse outcomes associated with a low Apgar score in approximately 235,000 children born in Norway in the years 1983-1987. All had a birth weight of 2500 g or greater, and none had birth defects (other than congenital hip dislocation) when followed to age 8 to 12 years. A 5-minute Apgar score of 3 or lower was recorded in 0.1% of infants, whereas 0.6% had scores of 4 to 6. The former group had neonatal and infant mortality rates of 16.4 and 19.2%, respectively. Mortality was 3% between ages 1 and 8 years for children with scores of 0 to 3. Of those who lived beyond age 12 months despite a score of 0 to 3, 6.8% were receiving benefits because of cerebral palsy (CP) by age 8 to 12 years. Compared with infants whose 5-minute Apgar scores were 7 to 10, those with scores of 0 to 3 were 386 times likelier to die neonatally, 76 times likelier to die within the first year of life, and 81 times more likely to develop CP. These effects were even more marked when 1- and 5-minute Apgar scores were combined. Neonatal deaths were increased 642-fold when both scores were 3 or lower. Parent reports of CP coincided completely with a discharge diagnosis of CP. Both low Apgar scores and later CP correlated with seizures, feeding problems, and respiratory difficulty in the first week of life. Low Apgar scores were strongly associated with both infant death and CP in this population, in which low scores are relatively infrequent. These findings suggests that the Apgar score still is important for the early detection of infants at increased risk for serious or fatal conditions.