title: Five-minute Apgar score as a marker for developmental vulnerability at 5 years of age.
abstract: OBJECTIVE
  To assess the relationship between the 5 min Apgar score and developmental vulnerability at 5 years of age.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  Manitoba, Canada.
  
  
  METHODS
  All children born between 1999 and 2006 at term gestation, with a documented 5 min Apgar score.
  
  
  METHODS
  5 min Apgar score.
  
  
  METHODS
  Childhood development at 5 years of age, expressed as vulnerability (absent vs present) on five domains of the Early Development Instrument: physical health, social competence, emotional maturity, language and cognitive development, and communication skills.
  
  
  RESULTS
  Of the 33,883 children in the study, most (82%) had an Apgar score of 9; 1% of children had a score <7 and 5.6% had a score of 10. Children with Apgar scores <10 had higher odds of vulnerability on the physical domain at age 5 years compared with children with a score of 10 (eg, adjusted OR (aOR) for Apgar 9=1.23, 95% CI 1.05 to 1.44). Similarly, children with Apgar scores of <10 were more vulnerable on the emotional domain (eg, aOR for Apgar 9=1.20, 95% CI 1.03 to 1.41). Nevertheless, the Apgar-based prognostic model had a poor sensitivity for physical vulnerability (19%, 95% CI 18% to 20%). Although the Apgar score-based prognostic model had reasonable calibration ability and risk-stratification accuracy for identifying developmentally vulnerable children, classification accuracy was poor.
  
  
  CONCLUSIONS
  The risk of developmental vulnerability at 5 years of age is inversely associated with the 5 min Apgar score across its entire range, and the score can serve as a population-level indicator of developmental risk.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Neda
authors.initials: N
authors.lastname: Razaz
authors.affiliation: Departments of Pediatrics and Psychiatry, School of Medicine, University of California, San Francisco, California, USA.
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Boyce
authors.affiliation: Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Marni
authors.initials: M
authors.lastname: Brownell
authors.affiliation: School of Public Health, University of California, Berkeley, California, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Jutte
authors.affiliation: Brain Research Centre and Department of Medicine (Division of Neurology), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Tremlett
authors.affiliation: Departments of Internal Medicine and Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
mesh_terms: D001034:Apgar Score; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D015233:Models, Statistical; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Child Psychology; Comm Child Health; Epidemiology