Evidence map›Paper›PMID 40661038›Full record

Observational studyBJOG : an international journal of obstetrics and gynaecology2026

Five-Minute Apgar Scores and Its Prognostic Value for Mortality and Severe Morbidity in Very Preterm Infants: A Multinational Cohort Study.

Harald Ehrhardt, Soodabeh Behboodi, Rolf F Maier, Adrien M Aubert, Ulrika Åden, Elizabeth S Draper, Anna Gudmundsdottir, Veronica Siljehav, Heili Varendi, Tom Weber and 3 more

Abstract readMulticenter StudyObservational Study
In one paragraph

Observational study in BJOG : an international journal of obstetrics and gynaecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Harald EhrhardtDivision of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.ORCID https://orcid.org/0000-0003-4587-1734
Soodabeh BehboodiCentre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology, OPPaLE, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Paris, France.
Rolf F MaierChildren's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany.
Adrien M AubertCentre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology, OPPaLE, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Paris, France.
Ulrika ÅdenDepartment of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Elizabeth S DraperDepartment of Health Sciences, University of Leicester, Leicester, UK.
Anna GudmundsdottirDepartment of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Veronica SiljehavDepartment of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Heili VarendiUniversity of Tartu, Tartu University Hospital, Tartu, Estonia.
Tom WeberUniversity of Copenhagen, Copenhagen, Denmark.
Michael ZemlinHospital for General Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany.
Jennifer ZeitlinCentre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology, OPPaLE, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Paris, France.ORCID https://orcid.org/0000-0002-9568-2969
EPICE/SHIPS Research Group

Funding

European Union's 7th FrameworkHorizon 2020 Framework Programme
6 · The paper itself

Abstract

objectiveTo examine associations between a 5-min Apgar score < 7 and severe neonatal outcomes in very preterm (VPT) infants and how results are impacted by variations in assigning Apgar scores within an international context.

designProspective observational population-based cohort study.

settingEleven structurally and organisationally diverse countries across Europe. POPULATION: In total, 7900 liveborn VPT infants from the EPICE-SHIPS study.

methodsDescriptive statistics, logistic regression, modified Poisson regression.

main outcome measuresAssociations between 5-min Apgar scores < 7 and adverse neonatal outcomes were estimated with adjustments for perinatal characteristics. We tested for interactions by country-level prevalence of an Apgar score < 7, grouped into low (14%-16%), medium (19%-22%) and high (28%-40%).

results20.2% of infants had 5-min Apgar score < 7 with rates of 14%-40% across countries. A score < 7 increased risks of in-hospital mortality, intraventricular haemorrhage (IVH), cystic periventricular leukomalacia (cPVL), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and length of hospital stay (LHS), but not necrotising enterocolitis or late-onset infection (LOI). No interactions with country group were detected for mortality, cPVL and ROP, while associations with IVH, BPD and LHS were restricted to countries with lower prevalence of scores < 7.

conclusionsSignificant differences exist in the prevalence of low Apgar scores across countries. Their interactions with adverse outcomes demand caution when using the Apgar score in prognostic models for clinical care and research without local validation. More broadly, our findings emphasise the importance of accounting for country-specific effects in clinical assessment scores.

Indexed as

Apgar ScoreInfant, Extremely PrematureInfant, Premature, DiseasesCohort StudiesEuropeFemaleHospital MortalityHumansInfant MortalityInfant, NewbornInfant, PrematureMalePrognosisProspective StudiesApgar scorebronchopulmonary dysplasiaintraventricular haemorrhagemortalitypreterm infantprognostic factorretinopathy of prematurity

Identifiers

PMID40661038
PMCPMC12884215

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.