ArticleJAMA network open2023
Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm.
Article in JAMA network open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Prevalence of survival without major morbidity and associated risk factors among very preterm infants: a systematic review and meta-analysis.Frontiers in pediatrics · 2025Pooled it
- Association between parental firefighting status and adverse birth outcomes in Arizona: a cross-sectional study.Occupational and environmental medicine · 2026Article
- Five-Minute Apgar Scores and Its Prognostic Value for Mortality and Severe Morbidity in Very Preterm Infants: A Multinational Cohort Study.BJOG : an international journal of obstetrics and gynaecology · 2026Observational
- Apgar Score Plus Umbilical Artery pH and Adverse Neonatal Outcomes in Very Preterm Infants.JAMA network open · 2026Article
- Maternal polycystic ovary syndrome and the risk of neurodevelopmental disorders in preterm neonates.Pediatric endocrinology, diabetes, and metabolism · 2026Article
- Effect of fresh-frozen plasma transfusion on intraventricular hemorrhage risk in preterm infants with prolonged APTT: a target trial emulation with causal forest analysis.Frontiers in neuroscience · 2026Article
- Observational
- A cross-sectional study on posttraumatic growth and influencing factors among parents of premature infants.BMC pregnancy and childbirth · 2025Article
- Construction and validation of an educational booklet on prematurity for pregnant women, postpartum women and family members.Revista brasileira de enfermagem · 2025Article
- Neuromuscular components of Apgar score in predicting delivery room respiratory support.Pediatric research · 2024Article
- Machine Learning for the Identification of Key Predictors to Bayley Outcomes: A Preterm Cohort Study.Journal of personalized medicine · 2024Article
- The Importance of Follow-Up Visits for Children at Risk of Developmental Delay-A Review.Diagnostics (Basel, Switzerland) · 2024Review
- Trends in Apgar scores and umbilical artery pH: a population-based cohort study on 10,696,831 live births in Germany, 2008-2022.European journal of pediatrics · 2024Article
- Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants - an Australian population-based cohort study.The Lancet regional health. Western Pacific · 2024Article
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Authors and funding
11 authors at 9 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. Objective: To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. Design, Setting, and Participants: This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Exposures: Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Main Outcomes and Measures: Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. Results: From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). Conclusions and Relevance: This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
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