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

Tamar Wainstock, Asnat Walfisch, Ilana Shoham-Vardi, Idit Segal, Ruslan Sergienko, Eyal Sheiner

Research output: Contribution to journalMeeting Abstractpeer-review


Low Apgar scores (<7) measured at age 5 minutes can predict short- term infant morbidity and mortality. We aimed to study the risk for long term infectious morbidity in term infants with low 5 minutes Apgar scores compared to infants with higher Apgar scores, during a follow- up period of up to 18 years.

Study Design
A population based cohort analysis was performed comparing total as well as specific subtypes of infectious morbidity leading to hospitalization (up to the age of 18 years) among newborns with normal (≥7) and low (<7) 5 minutes Apgar scores. The analysis included all term singletons born between the years 1999-2013 at a single tertiary regional medical center. Infants with congenital malformations and perinatal deaths were excluded. Infectious morbidity included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in the hospital medical records. A Kaplan-Meier survival curve was constructed to compare the cumulative infectious morbidity incidence, and a Cox proportional hazards model was used to adjust for suspected confounders.

The study population of 223 224 term singletons, was followed for an average of 9.74±6.21 years (0-18 years, median 9.96) following discharge from birth hospitalization. There were 585 (0.3%) infants with low 5 minutes Apgar scores and 222 659 (99.7%) with normal Apgar scores . Rates of selected infectious disease categories are presented in the Table. The rate of infectious morbidity was 9.8% among normal vs. 12.4% among newborns with low 5 minutes Apgar scores (p<0.001; incidence density ratios 10/1000 person years (py) vs. 14.7/1000 py ; RR= 1.47; 95%CI 1.38-1.55). The log survival curve related to infectious disease hospitalization by the study group is presented in the figure (Log Rank test p<0.001). Adjusting for maternal age, gestational age, pregnancy induced hypertension and gestational diabetes, using a Cox proportional hazards model, the association remained statistically significant (Adjusted HR= 1.35; 95%CI 1.07-1.70).

Our results suggest that term infants with Low 5 minutes Apgar scores may be at an increased risk for long-term pediatric infectious morbidity.
Original languageEnglish GB
Pages (from-to)S328-S328
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2017


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