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)

概要

Apgar score (AS), an assessment tool to evaluate neonatal
vitality based on the perinatal status and effects of resuscitation [1, 2], comprises 5 items: heart rate, respiratory
effort, reflex irritability, muscle tone, and color at birth [1].
A neonate is assessed at 1 and 5 min after birth and each
item is attributed a score of 0, 1, or 2 (total score range,
0–10 for each assessment) [1]. A population-based study
on more than two million children reported the following
distribution of Apgar scores (ASs) at 5 min: ≤ 3, ≤ 6, 9, and
10 (0.3%, 1.1%, 25.3%, and 67.9%, respectively) [3]. However, interobserver variability, perinatal complications, and
interventions delivered to the mother and neonate affect the
calculation of an AS [1, 4].
ASs were not originally intended for use as a long-term
prognostic tool [1]. However, in recent studies, associations
between low ASs and death [5–7], cerebral palsy [7–9],
and autism[10–12] have been reported. Findings regarding
associations of the ASs with childhood development remain
controversial, as studies have used different AS categories
and outcome measurements [13–16]. Studies[6, 17] have
found that the ASs were associated with neonatal and longterm complications, including child development [6, 18–21];
however, they did not sufficiently adjust for the important
perinatal status confounders.
Therefore, we aimed to determine whether ASs ≥ 7 (considered normal) were associated with the child developmental status at 3 years of age and to identify an optimal
cutoff value of ASs in relation to the developmental status,
including the perinatal confounders. To accomplish these
objectives, we used a nationwide cohort dataset in Japan. ...