The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
, Ramat Gan, Israel.
Eur J Pediatr. 2020 Jun;179(6):959-971. doi: 10.1007/s00431-020-03593-9. Epub 2020 Feb 3.
Since introduced, the Apgar score has remained the most widespread predictor for neonatal morbidity and mortality. We aimed to investigate the association between low 5-min Apgar score and long-term infectious pediatric morbidity. A population-based cohort analysis was performed comparing total and specific subtypes of infectious morbidity leading to hospitalization among term newborns with normal (≥ 7) and low (< 7) 5-min Apgar scores, born between 1999 and 2014 at a single tertiary regional hospital. Infectious morbidity included hospitalizations involving a pre-defined set of infection-related ICD-9 codes. A Kaplan-Meier survival curve was constructed to compare cumulative infectious morbidity incidence and a Cox proportional hazards model to adjust for confounders. The long-term analysis of 223,335 children (excluding perinatal death cases) yielded 585 (0.3%) infants with low 5-min Apgar scores. The rate of infection-related hospitalizations was 9.8% and 12.4% among newborns with normal and low 5-min Apgar scores, respectively (p = 0.06). Adjusting for maternal age, gestational age, hypertension, diabetes, cesarean delivery, and fertility treatments, the association proved to be statistically significant (adjusted HR = 1.28; 95% CI 1.01-1.61).Conclusion: Term infants with low 5-min Apgar scores may be at an increased risk for long-term pediatric infectious morbidity.What is Known:• Though not meant to be a prognostic tool for long-term morbidity, studies assessing the correlation between low Apgar score and long-term outcomes were and are being performed, reporting significant associations with many outcomes-such as cerebral palsy (CP), ophthalmic disorders, GI disorders, and several types of malignancies.• Yet, an association between low Apgar scores and future health remains a matter of controversy.What is New:• Our work shows that a low 5-min Apgar score is independently associated with long-term pediatric infection-related hospitalizations among term singleton newborns.
自引入以来，阿普加评分一直是预测新生儿发病率和死亡率最广泛的指标。我们旨在研究低 5 分钟阿普加评分与长期传染性儿科发病率之间的关系。在一家单中心三级区域医院，对 1999 年至 2014 年期间出生的足月新生儿进行了一项基于人群的队列分析，比较了正常（≥7 分）和低（<7 分）5 分钟阿普加评分与总发病率和特定类型的传染性发病率之间的关系。传染病发病率包括涉及预定义的一组与感染相关的 ICD-9 代码的住院治疗。构建 Kaplan-Meier 生存曲线比较累积传染性发病率，并使用 Cox 比例风险模型进行调整以控制混杂因素。对 223335 名儿童（不包括围产期死亡病例）的长期分析显示，有 585 名（0.3%）婴儿的 5 分钟阿普加评分较低。正常 5 分钟 Apgar 评分和低 Apgar 评分的新生儿中，与感染相关的住院率分别为 9.8%和 12.4%（p=0.06）。调整母亲年龄、胎龄、高血压、糖尿病、剖宫产和生育治疗后，相关性具有统计学意义（调整 HR=1.28；95%CI 1.01-1.61）。结论：5 分钟 Apgar 评分低的足月婴儿可能存在长期儿科感染发病率增加的风险。已知：虽然不是长期发病的预后工具，但评估低 Apgar 评分与长期结局之间相关性的研究已经在进行，并报告了与许多结局之间存在显著相关性，如脑瘫（CP）、眼部疾病、胃肠道疾病和多种类型的恶性肿瘤。然而，低 Apgar 评分与未来健康之间的关系仍然存在争议。新内容：我们的工作表明，低 5 分钟 Apgar 评分与足月单胎新生儿长期儿科感染相关住院治疗独立相关。
