Skip to main content

Advertisement

SpringerLink
Log in

A prospective cohort study of the association between the Apgar score and developmental status at 3 years of age: the Japan Environment and Children’s Study (JECS)

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

Abstract

Apgar score (AS) is a well-established tool for assessing viability of newborns, and its association with subsequent child development has been suggested. We aimed to assess whether Apgar scores (ASs) ≥ 7 (generally considered normal) are associated with the developmental status at 3 years of age while adjusting for perinatal and socioeconomic confounders. We extracted the data of ASs at 1 and 5 min among participants of the Japan Environment and Children’s Study datasets, which were used in this nationwide cohort study. The outcomes comprised developmental status that was less than each cutoff value for the following five domains of the Ages & Stages Questionnaire (Japanese version, 3rd edition): communication, gross and fine motor, problem-solving, and personal-social domains. For this objective, we conducted multivariable logistic regression analyses on the data of 54,716 children. Compared with ASs ≥ 9 at 5 min, the adjusted odds ratios (aOR) for delayed development in children with ASs ≤ 8 were 1.31 (95% confidence interval, 1.11–1.56), 1.20 (1.04–1.38), and 1.16 (1.01–1.34), respectively, for gross and fine motor, and problem-solving domains. Among neonates with ASs ≤ 8 at 1 min, when those with ASs ≤ 8 at 5 min were compared with those with ASs ≥ 9 at 5 min, the aOR for gross motor domain was 1.34 (1.11–1.61).

Conclusion: ASs ≤ 8 compared with those ≥ 9 at 5 min, even considering the change of AS from 1 to 5 min, were associated with increased ORs for developmental delay in 3-year-olds. Even ASs that are considered normal might affect the subsequent development.

What is Known:

• Apgar score is a general tool for evaluating the vitality of newborns. It is also basically measured at 1 minute and 5 minutes after birth and the scores of ≥7 are considered normal.

• The Apgar scores at each minute affect clinical findings of neonates after birth and the subsequent long-term development.

What is New:

• Neonates with Apgar scores of ≤8 at 5 minutes compared with those of ≥9, including the change in Apgar score from 1 minute to 5 minutes, are associated with increased odds ratios for developmental status at 3 years of age adjusting for perinatal and socioeconomic confounders.

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

Availability of data and material

Data are unsuitable for public deposition due to ethical restrictions and legal framework of Japan. It is prohibited by the Act on the Protection of Personal Information (Act No. 57 of 30 May 2003, amendment on 9 September 2015) to publicly deposit the data containing personal information. Ethical Guidelines for Medical and Health Research Involving Human Subjects enforced by the Japan Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare also restricts the open sharing of the epidemiologic data. All inquiries about access to data should be sent to: jecs-en@nies.go.jp. The person responsible for handling enquiries sent to this e-mail address is Dr Shoji F. Nakayama, JECS Program Office, National Institute for Environmental Studies.

Code availability

N/A.

Abbreviations

aOR:

Adjusted odds ratio

aRR:

Adjusted rate ratio

AS:

Apgar Score

ASQ-3:

Ages & Stages Questionnaire, 3rd Edition

ASs:

Apgar Scores

J-ASQ-3:

Ages & Stages Questionnaire (Japanese version, 3rd Edition)

JECS:

Japan Environment and Children’s Study

OR:

Odds ratio

95% CI:

95% Confidence interval

References

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

  2. American academy of pediatrics committee on fetus and newborn; American college of obstetricians and gynecologists committee on obstetric practice (2015) The Apgar Score Pediatrics 136:819–822

  3. Siddiqui A, Cuttini M, Wood R et al (2017) Can the Apgar score be used for international comparisons of newborn health? Paediatr Perinat Epidemiol 31:338–345

    Article  Google Scholar 

  4. Bharti B, Bharti S (2005) A review of the Apgar score indicated that contextualization was required within the contemporary perinatal and neonatal care framework in different settings. J Clin Epidemiol 58:121–129

    Article  Google Scholar 

  5. Cnattingius S, Johansson S, Razaz N (2020) Apgar score and risk of neonatal death among preterm infants. N Engl J Med 383:49–57

    Article  Google Scholar 

  6. Razaz N, Cnattingius S, Joseph K (2019) Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden. BMJ:l1656

  7. Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T (2001) The association of Apgar score with subsequent death and cerebral palsy: a population-based study in term infants. J Pediatr 138:798–803

    Article  CAS  Google Scholar 

  8. Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S (2018) Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ:k207

  9. Lie KK, Groholt E-K, Eskild A (2010) Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ 341:c4990

  10. Modabbernia A, Sandin S, Gross R et al (2019) Apgar score and risk of autism. Eur J Epidemiol 34:105–114

    Article  Google Scholar 

  11. Glasson EJ, Bower C, Petterson B, De Klerk N, Chaney G, Hallmayer JF (2004) Perinatal factors and the development of autism. Arch Gen Psychiatry 61:618

    Article  Google Scholar 

  12. Polo-Kantola P, Lampi KM, Hinkka-Yli-Salomäki S, Gissler M, Brown AS, Sourander A (2014) Obstetric risk factors and autism spectrum disorders in Finland. J Pediatr 164:358–365

    Article  Google Scholar 

  13. Källén K, Serenius F, Westgren M, Maršál K (2015) Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS). Acta Obstet Gynecol Scand 94:1203–1214

    Article  Google Scholar 

  14. Agarwal PK, Shi L, Rajadurai VS, Zheng Q, Yang PH, Khoo PC, Quek BH, Daniel LM (2018) Factors affecting neurodevelopmental outcome at 2 years in very preterm infants below 1250 grams: a prospective study. J Perinatol 38:1093–1100

    Article  Google Scholar 

  15. Gasparrini E, Rosati F, Gaetti MT (2019) Long-term follow-up of newborns at neurological risk. Ital J Pediatr 45:38

    Article  Google Scholar 

  16. Matsuda N, Taki A, Tsuji A, Nakajima K, Takasawa K, Morioka C, Minosaki Y, Oku K, Kashimada K, Morio T (2018) Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age. Clin Pediatr Endocrinol 27:31–38

    Article  Google Scholar 

  17. Ernest E, Wainstock T, Sheiner E, Segal I, Landau D, Walfisch A (2019) Apgar score and long-term respiratory morbidity of the offspring: a population-based cohort study with up to 18 years of follow-up. Eur J Pediatr 178:403–411

    Article  Google Scholar 

  18. Tweed EJ, Mackay DF, Nelson SM, Cooper S-A, Pell JP (2016) Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children. Arch Dis Child Fetal Neonatal Ed 101:F121–F126

    Article  Google Scholar 

  19. Moster D, Lie RT, Markestad T (2002) Joint association of Apgar scores and early neonatal symptoms with minor disabilities at school age. Arch Dis Child Fetal Neonatal Ed 86:F16–F21

    Article  CAS  Google Scholar 

  20. Gampel SB, Nomura Y (2014) Short and long-term effects of compromised birth weight, head circumference, and Apgar scores on neuropsychological development. J Psychol Abnorm Child 3:127

    PubMed  PubMed Central  Google Scholar 

  21. Razaz N, Cnattingius S, Persson M, Tedroff K, Lisonkova S, Joseph KS (2019) One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada. BMJ Open 9:e027655

  22. Kawamoto T, Nitta H, Murata K et al (2014) Rationale and study design of the Japan environment and children’s study (JECS). BMC Public Health 14:25

    Article  Google Scholar 

  23. Michikawa T, Nitta H, Nakayama SF et al (2018) Baseline profile of participants in the Japan environment and children’s study (JECS). J Epidemiol 28:99–104

    Article  Google Scholar 

  24. Yoshida S, Takeuchi M, Kawakami C, Kawakami K, Ito S (2020) Maternal multivitamin intake and orofacial clefts in offspring: Japan environment and children's study (JECS) cohort study. BMJ Open 10:e035817

  25. Yokoyama Y, Takachi R, Ishihara J et al (2016) Validity of short and long self-administered food frequency questionnaires in ranking dietary intake in middle-aged and elderly Japanese in the Japan public health center-based prospective study for the next generation (JPHC-NEXT) protocol area. J Epidemiol 26:420–432

    Article  Google Scholar 

  26. Singh A, Yeh CJ, Boone Blanchard S (2017) Ages and stages questionnaire: a global screening scale. Bol Med Hosp Infant Mex 74:5–12

    PubMed  Google Scholar 

  27. Mezawa H, Aoki S, Nakayama SF et al (2019) Psychometric profile of the ages and stages questionnaires, Japanese translation. Pediatr Int 61:1086–1095

    Article  Google Scholar 

  28. Metwally AM, Salah El-Din EM, Shehata MA et al (2016) Early life predictors of socio-emotional development in a sample of Egyptian infants. PLoS One 11:e0158086

  29. Fusco RA (2017) Socioemotional problems in children exposed to intimate partner violence: mediating effects of attachment and family supports. J Interpers Violence 32:2515–2532

    Article  Google Scholar 

  30. Iliodromiti S, Mackay DF, Smith GCS, Pell JP, Nelson SM (2014) Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet 384:1749–1755

    Article  Google Scholar 

Download references

Acknowledgments

We thank all the Japan Environment and Children’s Study (JECS) participants and all individuals who were involved in this data collection.

Funding

This study was funded by the Ministry of the Environment, Japan. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the above-mentioned government.

Author information

Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Tetsuya Tsuchida, Satomi Yoshida, Masato Takeuchi & Koji Kawakami

  2. Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

    Chihiro Kawakami & Shuichi Ito

  3. National Institute for Environmental Studies, Tsukuba, Japan

    Shuichi Ito

Authors
  1. Tetsuya Tsuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satomi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masato Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chihiro Kawakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Kawakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Japan Environment, Children’s Study Group

  • Michichiro Kamijima
  • , Shin Yamazaki
  • , Yukihiro Ohya
  • , Reiko Kishi
  • , Nobuo Yaegashi
  • , Koichi Hashimoto
  • , Chisato Mori
  • , Zentaro Yamagata
  • , Hidekuni Inadera
  • , Takeo Nakayama
  • , Hiroyasu Iso
  • , Masayuki Shima
  • , Youichi Kurozawa
  • , Narufumi Suganuma
  • , Koichi Kusuhara
  •  & Takahiko Katoh

Contributions

Conceptualization: Tetsuya Tsuchida, Satomi Yoshida, Masato Takeuchi, and Koji Kawakami; Data curation: Tetsuya Tsuchida, Chihiro Kawakami, and Shuichi Ito; Methodology: Tetsuya Tsuchida, Satomi Yoshida, and Masato Takeuchi; Formal analysis and investigation: Tetsuya Tsuchida; Writing – original draft preparation: Tetsuya Tsuchida; Writing – review and editing: Satomi Yoshida, Masato Takeuchi, Chihiro Kawakami, Koji Kawakami, and Shuichi Ito; Funding acquisition: Chihiro Kawakami and Shuichi Ito; Resources: Chihiro Kawakami and Shuichi Ito; Supervision: Satomi Yoshida, Masato Takeuchi, Chihiro Kawakami, Koji Kawakami, and Shuichi Ito.

Corresponding author

Correspondence to Koji Kawakami.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ministry of the Environment’s Institutional Review Board on Epidemiological Studies and the Ethics Committees of all participating institutions.

Consent to participate

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

Consent for publication

The participant has consented to the submission to this journal.

Conflict of interest

The authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

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

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsuchida, T., Yoshida, S., Takeuchi, M. et al. A prospective cohort study of the association between the Apgar score and developmental status at 3 years of age: the Japan Environment and Children’s Study (JECS). Eur J Pediatr 181, 661–669 (2022). https://doi.org/10.1007/s00431-021-04249-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-021-04249-y

Keywords

Search

Navigation