Apgar score and long-term respiratory morbidity of the offspring: a population-based cohort study with up to 18years of follow-up

The objective of this study is to investigate whether a significant association exists between low 5-min Apgar scores (<7) and respiratory morbidity of the offspring. A population-based cohort analysis was performed comparing subtypes of respiratory morbidity leading to hospitalizations among children (up to age 18years) stratified by their 5min Apgar scores. Data were collected from two databases of a regional tertiary center. All singleton deliveries occurring between 1991 and 2014 were included in the analysis. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory-related hospitalization incidence and a Cox proportional hazards model to control for confounders. Deliveries (238,622) met the inclusion criteria. Low 5-min Apgar scores were recorded in 742 (0.3%) newborns. Incidence of respiratory hospitalizations was higher among the low 5min Apgar score group (7.3 vs. 4.8% in the normal [7] 5min Apgar score group; OR=1.5, 95%CI 1.2-2.0, p=0.003). Association remained significant in the Cox model (aHR=1.4, 95%CI 1.1-1.9, p=0.01). Incidence of respiratory-related hospitalizations in preterm born offspring was higher among the low vs. the normal 5min Apgar score groups (13.4 vs. 7.2%, OR=2.0, 95%CI 1.2-3.1 , p=0.008). Association remained significant in the multivariable analysis (aHR=1.6, 95%CI 1.1-2.5, p=0.03). The survival curves demonstrated significantly higher cumulative respiratory morbidity in the low Agar score group for the entire cohort and for the preterm born subgroup.Conclusion: Newborns, of any gestational age, with low 5min Apgar scores appear to be at an increased risk for pediatric respiratory morbidity.