Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age.
OBJECTIVE
To examine whether the combination of a low five minute Apgar score and symptoms of neonatal encephalopathy is associated with minor impairments at school age.


METHODS
Population based cohort study.


METHODS
Norway.


METHODS
All 727 children of the cohort were born between 1983 and 1987, had normal birth weights, no congenital malformations, and no major neurological abnormalities. The cohort comprised three groups with five minute Apgar scores of 0-3, 4-6, and 7-10, and were followed from birth to 8-13 years of age by combining data from The Medical Birth Registry, questionnaires, hospital discharge summaries, and the National Insurance Scheme.


METHODS
Neurodevelopmental impairments such as learning, behavioural, and minor motor difficulties.


RESULTS
Children with a five minute Apgar score of 3 or less and signs consistent with neonatal encephalopathy had a significantly increased risk of developing minor motor impairments (odds ratio (OR) 12.8, 95% confidence interval (CI) 2.6 to 63.2), epilepsy (OR 7.0, 95% CI 1.3 to 39.2), need of extra resources in kindergarten (OR 7.0, 95% CI 1.3 to 39.2) or at school (OR 3.4, 95% CI 1.8 to 6.3), and had reduced performance in reading (OR 4.6, 95% CI 2.3 to 9.5) and mathematics (OR 3.3, 95% CI 1.5 to 7.3), compared with children with normal Apgar scores and no neonatal symptoms. They also more often had problems related to tractability, aggressivity, passivity, anxiety, academic performance, and fine motor development.


CONCLUSIONS
Children with low Apgar scores and subsequent signs of cerebral depression who do not develop cerebral palsy may still have an increased risk of developing a variety of neurodevelopmental impairments and learning difficulties.
Moster
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Department of Paediatrics, Haukeland University Hospital, N-5021 Bergen, Norway. Dag.Moster@smis.uib.no
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D001034:Apgar Score; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis; D002653:Child Behavior Disorders / Q000209:etiology; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007859:Learning Disabilities / Q000209:etiology; D019957:Motor Skills Disorders / Q000209:etiology; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries