Skip to main content

Advertisement

SpringerLink
Log in

Low Apgar score in term newborns and long-term infectious morbidity: a population-based cohort study with up to 18 years of follow-up

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Since introduced, the Apgar score has remained the most widespread predictor for neonatal morbidity and mortality. We aimed to investigate the association between low 5-min Apgar score and long-term infectious pediatric morbidity. A population-based cohort analysis was performed comparing total and specific subtypes of infectious morbidity leading to hospitalization among term newborns with normal (≥ 7) and low (< 7) 5-min Apgar scores, born between 1999 and 2014 at a single tertiary regional hospital. Infectious morbidity included hospitalizations involving a pre-defined set of infection-related ICD-9 codes. A Kaplan-Meier survival curve was constructed to compare cumulative infectious morbidity incidence and a Cox proportional hazards model to adjust for confounders. The long-term analysis of 223,335 children (excluding perinatal death cases) yielded 585 (0.3%) infants with low 5-min Apgar scores. The rate of infection-related hospitalizations was 9.8% and 12.4% among newborns with normal and low 5-min Apgar scores, respectively (p = 0.06). Adjusting for maternal age, gestational age, hypertension, diabetes, cesarean delivery, and fertility treatments, the association proved to be statistically significant (adjusted HR = 1.28; 95% CI 1.01–1.61).

Conclusion: Term infants with low 5-min Apgar scores may be at an increased risk for long-term pediatric infectious morbidity.

What is Known:

• Though not meant to be a prognostic tool for long-term morbidity, studies assessing the correlation between low Apgar score and long-term outcomes were and are being performed, reporting significant associations with many outcomes—such as cerebral palsy (CP), ophthalmic disorders, GI disorders, and several types of malignancies.

• Yet, an association between low Apgar scores and future health remains a matter of controversy.

What is New:

• Our work shows that a low 5-min Apgar score is independently associated with long-term pediatric infection-related hospitalizations among term singleton newborns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Apgar V. A proposal for a new method of evaluation of the newborn infant. Originally published in July 1953, volume 32, pages 250-259. Anesth Analg 2015;120(5):1056–1059

  2. Casey BM, McIntire DD, Leveno KJ (2001) The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 344(7):467–471

    Article  CAS  Google Scholar 

  3. Nelson SM, Iliodromiti S, Mackay DF, Pell JP, Smith GCS (2015) Apgar score and risk of cause-specific infant mortality - authors’ reply. Lancet (London, England) 385:506

  4. Shah P, Anvekar A, McMichael J, Rao S (2015) Outcomes of infants with Apgar score of zero at 10 min: the West Australian experience. Arch Dis Child Fetal Neonatal Ed 100(6):F492–F494

    Article  Google Scholar 

  5. Kasdorf E, Laptook A, Azzopardi D, Jacobs S, Perlman JM (2015) Improving infant outcome with a 10 min Apgar of 0. Arch Dis Child Fetal Neonatal Ed 100(2):F102–F105

    Article  Google Scholar 

  6. Lagatta J, Yan K, Hoffmann R (2012) The association between 5-min Apgar score and mortality disappears after 24 h at the borderline of viability. Acta Paediatr 101(6):e243–e247

    Article  Google Scholar 

  7. The Apgar Score. Pediatrics. 2015;136(4):819–22

  8. Kvestad E, Lie KK, Eskild A, Engdahl B (2014) Sensorineural hearing loss in children: the association with Apgar score. A registry-based study of 392,371 children in Norway. Int J Pediatr Otorhinolaryngol 78(11):1940–1944

    Article  Google Scholar 

  9. Jiang ZD, Zang Z, Wilkinson AR (2012) Cochlear function in 1-year-old term infants born with hypoxia-ischaemia or low Apgar scores. J Paediatr Child Health 48(2):160–165

    Article  Google Scholar 

  10. Gur Z, Tsumi E, Wainstock T, Walter E, Sheiner E (2018) Association between delivery of small-for-gestational age neonate and long-term pediatric ophthalmic morbidity. Arch Gynecol Obstet 298(6):1095–1099

    Article  CAS  Google Scholar 

  11. Leybovitz-Haleluya N, Wainstock T, Sheiner E, Segal I, Landau D, Walfisch A (2019) Low Apgar scores in term newborns and long-term gastro-intestinal morbidity: a population-based cohort study with up to 18 years of follow-up(). J Matern Fetal Neonatal Med 32(10):1609–1614

    Article  Google Scholar 

  12. Li J, Cnattingus S, Gissler M, Vestergaard M, Obel C, Ahrensberg J et al (2012) The 5-minute Apgar score as a predictor of childhood cancer: a population-based cohort study in five million children. BMJ Open 2(4)

  13. Nussbaum C, Gloning A, Pruenster M, Frommhold D, Bierschenk S, Genzel-Boroviczeny O et al (2013) Neutrophil and endothelial adhesive function during human fetal ontogeny. J Leukoc Biol 93(2):175–184

    Article  CAS  Google Scholar 

  14. McGreal EP, Hearne K, Spiller OB (2012) Off to a slow start: under-development of the complement system in term newborns is more substantial following premature birth. Immunobiology. 217(2):176–186

    Article  CAS  Google Scholar 

  15. Hanson LA (1998) Breastfeeding provides passive and likely long-lasting active immunity. Ann Allergy Asthma Immunol 81(6):523–524 537

    Article  CAS  Google Scholar 

  16. Statistics TCBo. Israel in Figures 2013 [cited 2015 May 25]. Available from: http://www.cbs.gov.il/www/publications/isr_in_n13e.pdf

  17. Lawn JE, Wilczynska-Ketende K, Cousens SN (2006) Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 35(3):706–718

    Article  Google Scholar 

  18. Gilead R, Yaniv Salem S, Sergienko R, Sheiner E (2012) Maternal “isolated” obesity and obstetric complications. J Matern Fetal Neonatal Med 25(12):2579–2582

    Article  Google Scholar 

  19. Gutvirtz G, Wainstock T, Landau D, Sheiner E (2019) Maternal smoking during pregnancy and long-term neurological morbidity of the offspring. Addict Behav 88:86–91

    Article  Google Scholar 

  20. Nahum Sacks K, Friger M, Shoham-Vardi I, Spiegel E, Sergienko R, Landau D, Sheiner E (2018) Prenatal exposure to preeclampsia as an independent risk factor for long-term cardiovascular morbidity of the offspring. Pregnancy Hypertens 13:181–186

    Article  Google Scholar 

  21. Wainstock T, Walfisch A, Shoham-Vardi I, Segal I, Sergienko R, Landau D, Sheiner E (2019) Term elective cesarean delivery and offspring infectious morbidity: a population-based cohort study. Pediatr Infect Dis J 38(2):176–180

    Article  Google Scholar 

  22. Wainstock T, Sheiner E, Yoles I, Sergienko R, Landau D, Harlev A (2019) Fertility treatments and offspring pediatric infectious morbidities: results of a population-based cohort with a median follow-up of 10 years. Fertil Steril 112(6):1129–1135

    Article  Google Scholar 

Download references

Acknowledgments

This study was conducted as part of the MD requirements of The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Author information

Author notes

  1. Dr. Wainstock equally contributed to this manuscript and is considered a second first author

Authors and Affiliations

  1. The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Yuval Gutbir

  2. Ramat Gan, Israel

    Yuval Gutbir

  3. Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Tamar Wainstock & Ruslan Sergienko

  4. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Eyal Sheiner & Asnat Walfisch

  5. Ministry of Health, Jerusalem, Israel

    Idit Segal

  6. Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Daniella Landau

Authors
  1. Yuval Gutbir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamar Wainstock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eyal Sheiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Idit Segal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruslan Sergienko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniella Landau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Asnat Walfisch
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yuval Gutbir drafted the initial and final manuscript and approved the final manuscript as submitted.

Asnat Walfisch and Eyal Sheiner conceptualized and designed the study, executed the study and data collection and analysis, critically reviewed the manuscript, and approved the final manuscript as submitted.

Tamar Wainstock helped in conceptualizing and designing the study with special attention to the statistical analyses and the figures, critically reviewed the manuscript, and approved the final manuscript as submitted.

Daniela Landau contributed with her expertise on this subject, helped in conceptualizing the study, supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Idit Segal contributed with her expertise on this subject, helped in conceptualizing the study, supervised data collection, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.

Ruslan Sergienko contributed with his expertise on this subject, helped in conceptualizing the study, supervised data collection, and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yuval Gutbir.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Nicole Ritz

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 5 Infectious diseases ICD-9 codes
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gutbir, Y., Wainstock, T., Sheiner, E. et al. Low Apgar score in term newborns and long-term infectious morbidity: a population-based cohort study with up to 18 years of follow-up. Eur J Pediatr 179, 959–971 (2020). https://doi.org/10.1007/s00431-020-03593-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-020-03593-9

Keywords

Search

Navigation