Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
BMJ. 2010 Oct 6;341:c4990. doi: 10.1136/bmj.c4990.
To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia.
Population based cohort study.
The Medical Birth Registry of Norway was used to identify all babies born between 1986 and 1995. These data were linked to the Norwegian Registry of Cerebral Palsy in Children born 1986-95, which was established on the basis of discharge diagnoses at all paediatric departments in Norway.
All singletons without malformations born in Norway during 1986-95 and who survived the first year of life (n=543 064).
Cerebral palsy diagnosed before the age of 5 years.
988 children (1.8 in 1000) were diagnosed with cerebral palsy before the age of 5 years. In total, 11% (39/369) of the children with Apgar score of less than 3 at birth were diagnosed with cerebral palsy, compared with only 0.1% (162/179 515) of the children with Apgar score of 10 (odds ratio (OR) 53, 95% CI 35 to 80 after adjustment for birth weight). In children with a birth weight of 2500 g or more, those with an Apgar score of less than 4 were much more likely to have cerebral palsy than those who had an Apgar score of more than 8 (OR 125, 95% confidence interval 91 to 170). The corresponding OR in children weighing less than 1500 g was 5 (95% CI 2 to 9). Among children with Apgar score of less than 4, 10-17% in all birthweight groups developed cerebral palsy. Low Apgar score was strongly associated with each of the three subgroups of spastic cerebral palsy, although the association was strongest for quadriplegia (adjusted OR 137 for Apgar score <4 v Apgar score >8, 95% CI 77 to 244).
Low Apgar score was strongly associated with cerebral palsy. This association was high in children with normal birth weight and modest in children with low birth weight. The strength of the association differed between subgroups of spastic cerebral palsy. Given that Apgar score is a measure of vitality shortly after birth, our findings suggest that the causes of cerebral palsy are closely linked to factors that reduce infant vitality.
评估出生后 5 分钟时的阿普加评分与正常体重和低出生体重儿童脑瘫之间的关系，以及与脑瘫的四肢瘫、双瘫和偏瘫等亚诊断的关系。
基于人群的队列研究。
挪威医学出生登记处用于识别 1986 年至 1995 年间出生的所有婴儿。这些数据与 1986-95 年在挪威出生的脑瘫儿童登记处相关联，该登记处是基于挪威所有儿科部门的出院诊断建立的。
1986-95 年间在挪威出生且在 1 岁时存活的所有无畸形的单胎儿（n=543064）。
5 岁前诊断为脑瘫。
988 名儿童（每 1000 名儿童中有 1.8 名）在 5 岁前被诊断为脑瘫。在出生时阿普加评分低于 3 分的儿童中，有 11%（39/369）被诊断为脑瘫，而在出生时阿普加评分为 10 分的儿童中，这一比例仅为 0.1%（162/179515）（调整出生体重后比值比（OR）为 53，95%置信区间为 35 至 80）。在出生体重为 2500 克或以上的儿童中，阿普加评分低于 4 分的脑瘫可能性远高于评分高于 8 分的儿童（OR 125，95%置信区间 91 至 170）。出生体重不足 1500 克的儿童的相应 OR 为 5（95%置信区间 2 至 9）。在阿普加评分低于 4 分的儿童中，所有出生体重组有 10-17%发展为脑瘫。低阿普加评分与痉挛性脑瘫的三个亚组均有强烈关联，尽管与四肢瘫的关联最强（调整后 OR 137，阿普加评分<4 与阿普加评分>8，95%置信区间 77 至 244）。
低阿普加评分与脑瘫密切相关。这一关联在出生体重正常的儿童中较高，在出生体重低的儿童中较低。痉挛性脑瘫的亚组之间关联强度不同。鉴于阿普加评分是出生后不久的生命活力指标，我们的发现表明脑瘫的病因与降低婴儿活力的因素密切相关。
