Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm
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Published:2023-09-06
Issue:9
Volume:6
Page:e2332413
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Ehrhardt Harald1, Aubert Adrien M.2, Ådén Ulrika3, Draper Elizabeth S.4, Gudmundsdottir Anna3, Varendi Heili5, Weber Tom6, Zemlin Michael7, Maier Rolf F.8, Zeitlin Jennifer2, Lebeer Jo9, van Reempts Patrick9, Bruneel Els9, Cloet Eva9, Oostra Ann9, Ortibus Els9, Sarrechia Iemke9, Boerch Klaus9, Huusom Lene9, Pedersen Pernille9, Hasselager Asbjørn9, Toome Liis9, Männamaa Mairi9, Ancel Pierre-Yves9, Burguet Antoine9, Jarreau Pierre9, Pierrat Véronique9, Truffert Patrick9, Misselwitz Björn9, Schmidt Stephan9, Wohlers Lena9, Cuttini Maria9, Di Lallo Domenico9, Ancora Gina9, Baronciani Dante9, Carnielli Virgilio9, Croci Ileana9, Faldella Giacomo9, Ferrari Frederica9, Franco Francesco9, Gargano Giancarlo9, van Heijst Arno9, Koopman-Esseboom Corine9, Gadzinowski Janusz9, Mazela Jan9, Montgomery Alan9, Pikuła Tomasz9, Barros Henrique9, Costa Raquel9, Graça Luís9, do Céu Machado Maria9, Rodrigues Carina9, Rodrigues Teresa9, Edstedt Bonamy Anna-Karin9, Norman Mikael9, Boyle Elaine9, Fenton Alan9, Johnson Samantha9, Manktelow Bradley9, Milligan David9, Mader Silke9, Thiele Nicole9, Walz Johanna9, Petrou Stavros9, Bonet Mercedes9, Bonnet Camille9, El Raffei Rym9, Piedvache Aurélie9, Seppänen Anna-Veera9,
Affiliation:
1. Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany 2. Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France 3. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden 4. Department of Health Sciences, University of Leicester, Leicester, United Kingdom 5. University of Tartu, Tartu University Hospital, Tartu, Estonia 6. University of Copenhagen, Copenhagen, Denmark 7. Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany 8. Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany 9. for the EPICE-SHIPS Research Group
Abstract
ImportanceThe Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks’ gestation) is not well established.ObjectiveTo investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT.Design, Setting, and ParticipantsThis cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023.ExposuresApgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points).Main Outcomes and MeasuresCognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children–Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables.ResultsFrom the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = −3.3; 95% CI, −10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = −2.1; 95% CI, −24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = −4.0; 95% CI, −20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI −11.7 to 13.3).Conclusions and RelevanceThis study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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