Epilepsy and cerebral palsy risks are inversely related to 5- and 10-minute Apgar scores in singlet newborns born at term, according to a study published in the BMJ.

Martina Persson, MD, PhD, of the Department of Medicine and Clinical Epidemiology Unit of Karolinska Institutet in Sweden, and associates conducted a population-based group study to assess the relationship between Apgar scores and pediatric cerebral palsy or epilepsy risks in infants born after 37 weeks of development.

Infants without malformations born between 1999 and 2012 in Sweden were tested for vital signs and stimuli responsiveness using Apgar scores at 5 and 10 minutes immediately after birth. The study included 1,213,470 singlet newborns.

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The main outcome was to detect the presence of cerebral palsy and epilepsy of participants up to age 16. Cerebral palsy and epilepsy were reported in 0.1% and 0.3% of participants, respectively.

The decrease in Apgar scores was related to an increase in cerebral palsy when participants were compared at 5 minutes with children with an Apgar score of 10. At 5 minutes, an Apgar score of 9 resulted in an adjusted hazard ratio of 1.9, while a score of 0 resulted in an adjusted hazard ratio of 277.7 for cerebral palsy. More significant correlations were observed at 10 minutes in cerebral palsy. Apgar scores of 7, 8, and 9 yielded hazard ratios of 18.7, 9.1, and 2.4, respectively.

The correlation between epilepsy and Apgar scores was not as significant. At 5 minutes, Apgar scores of 0 and 3 resulted in hazard ratios of 11.9 and 4.4, respectively. A stronger correlation of epilepsy was observed with lower Apgar scores at 10 minutes than at 5 minutes due to the small cohort with scores between 0 and 3 (HR, 11.0 for score 0; HR, 6.3 for score 2; HR, 15.8 for score 3).

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“We found increasing risks of epilepsy and especially cerebral palsy with decreasing Apgar scores at 5 and 10 minutes in offspring born at term,” reported the authors. “We believe that our findings are widely applicable and provide justification for assigning all newborns an Apgar score at 1, 5, and 10 minutes and continuing active neonatal resuscitation of infants who are mildly compromised at five minutes.”


  1. Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ. 2018 Feb 8. doi: 10.1136/bmj.k207