Article Text

Download PDFPDF

One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada
  1. Neda Razaz1,
  2. Sven Cnattingius2,
  3. Martina Persson1,
  4. Kristina Tedroff3,
  5. Sarka Lisonkova4,
  6. K S Joseph4
  1. 1 Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2 Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
  3. 3 Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Neda Razaz; neda.razaz{at}


Objectives We investigated the associations between Apgar scores at 1 and 5 min, across the entire range of score values, and child developmental health at 5 years of age.

Setting British Columbia, Canada

Participants All singleton term infants without major congenital anomalies born between 1993 and 2009, who had a developmental assessment in kindergarten between 1999 and 2014.

Main outcomes and measures Developmental vulnerability on one or more domains of the Early Development Instrument and special needs requirements. Adjusted rate ratios (aRRs) and 95% CIs were estimated using log-linear regression.

Results Of the 150 081 children in the study, 45 334 (30.2%) were developmentally vulnerable and 3644 (2.5%) had special needs. There was an increasing trend in developmental vulnerability and special needs with decreasing 1 min and 5 min Apgar scores. Compared with children with an Apgar score of 10 at 5 min, the aRR for developmental vulnerability increased steadily with decreasing Apgar score from 1.02 (95% CI 1.00 to 1.04) for an Apgar score of 9 to 1.57 (95% CI 1.03 to 2.39) for an Apgar score of 2. Among children with 1 min Apgar scores in the 7–10 range, changes in Apgar scores between 1 and 5 min were associated with significant differences in developmental vulnerability. Compared with children who had an Apgar score of 9 at 1 min and 10 at 5 min, children with an Apgar score of 9 at both 1 and 5 min had higher rates of developmental vulnerability (aRR 1.03, 95% CI 1.01 to 1.05). Compared with infants with an Apgar of 10 at both 1 and 5 min, infants with a 1 min score of 10 and a 5 min score of <10 had higher rates of developmental vulnerability (aRR 1.53, 95% CI 1.08 to 2.17).

Conclusion Risks of adverse developmental health and having special needs at 5 years of age are inversely associated with 1 min and 5 min Apgar scores across their entire range.

  • neonatology
  • epidemiology
  • fetal medicine
  • paediatrics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors NR conceptualised and designed the study, analysed the data, drafted the initial manuscript and finalised the manuscript based on co-authors' feedback. She had full access to all the data used in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SC, MP, KT and SL reviewed and commented on the initial and final analyses, provided feedback on the initial draft of the manuscript and approved the final version of the manuscript. KJ assisted with conceptualisation and design of the study, reviewed and commented on the initial and final analyses, provided feedback on the initial draft of the manuscript and approved the final version of the manuscript.

  • Funding NR is supported by a postdoctoral fellowship award from the Canadian Institutes of Health Research (CIHR). KJ is supported by the BC Children’s Hospital Research Institute.

  • Disclaimer All inferences, opinions and conclusions drawn in this journal article are those of the authors and do not reflect the opinions or policies of the data steward(s).

  • Competing interests None declared.

  • Ethics approval The University of British Columbia’s Clinical Research Ethics Board approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.