NEW YORK (Reuters Health) – Lower five- and 10-minute Apgar scores, even within the normal range, are associated with higher risks of childhood cerebral palsy and epilepsy, according to findings from Swedish registries.
“It is interesting that risks of cerebral palsy and epilepsy increase with decreasing Apgar scores over the whole range of scores and that even very modestly depressed Apgar scores increase these risks,” Dr. Martina Persson from Karolinska Institute in Stockholm told Reuters Health by email. “It is also noteworthy that small changes in Apgar scores between five and 10 minutes impact risks.”
Apgar scores of 7 to 10 are considered normal, while lower scores indicate depressed vitality. Previous studies have shown associations between low Apgar scores and increased risks of cerebral palsy and epilepsy, but none have investigated the risk of these disorders in children with Apgar scores across the full range.
Dr. Persson’s team used data on 1.2 million non-malformed live singleton infants from Swedish national registries to investigate associations between Apgar score at five and 10 minutes across the entire range of scores, as well as the effect of changes in Apgar scores from five to 10 minutes after birth, and the risks of childhood cerebral palsy or epilepsy among infants born at or beyond 37 weeks of gestation.
Overall, the incidence of cerebral palsy was 1.5 per 10,000 child-years, and the incidence of epilepsy was 5.1 per 10,000 child-years.
The risks of both outcomes increased significantly with decreasing Apgar score values, the team reports in The BMJ, online February 8.
For cerebral palsy, the adjusted hazard ratios increased from 1.9 among children with an Apgar score of 9 at five minutes to 277.7 with an Apgar score of 0 at five minutes, compared to a five-minute score of 10. Low Apgar scores at 10 minutes were associated with even higher hazard ratios of cerebral palsy.
Similarly, hazard ratios for epilepsy increased from 1.1 among children with five-minute Apgar scores of 9 to 11.9 among those with a five-minute Apgar score of 0. Here, too, low Apgar scores were more strongly associated with epilepsy at 10 minutes than at five minutes.
“We have not investigated if active neonatal resuscitation reduces the risks associated with low Apgar scores,” Dr. Persson said. “There are many reasons for low Apgar scores and both epilepsy and cerebral palsy are heterogeneous conditions with varying pathophysiological background and clinical presentation. However, it is possible that risks of cerebral palsy and epilepsy may be reduced given a proactive neonatal management.”
“I would recommend medical staff working with newborns to assign all infants an Apgar score at 1, 5, and 10 minutes and to continue active resuscitation of all infants who have not reached 10 points at 5 or 10 minutes,” she said.
SOURCE: http://bit.ly/2BYlcSi
BMJ 2018.
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