{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T21:19:19Z","timestamp":1793049559813,"version":"4.5.0"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine associations between a 5\u2010min Apgar score &lt;\u20097 and severe neonatal outcomes in very preterm (VPT) infants and how results are impacted by variations in assigning Apgar scores within an international context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective observational population\u2010based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Eleven structurally and organisationally diverse countries across Europe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>In total, 7900 liveborn VPT infants from the EPICE\u2010SHIPS study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Descriptive statistics, logistic regression, modified Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Associations between 5\u2010min Apgar scores &lt;\u20097 and adverse neonatal outcomes were estimated with adjustments for perinatal characteristics. We tested for interactions by country\u2010level prevalence of an Apgar score &lt;\u20097, grouped into low (14%\u201316%), medium (19%\u201322%) and high (28%\u201340%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>20.2% of infants had 5\u2010min Apgar score &lt;\u20097 with rates of 14%\u201340% across countries. A score &lt;\u20097 increased risks of in\u2010hospital mortality, intraventricular haemorrhage (IVH), cystic periventricular leukomalacia (cPVL), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and length of hospital stay (LHS), but not necrotising enterocolitis or late\u2010onset infection (LOI). No interactions with country group were detected for mortality, cPVL and ROP, while associations with IVH, BPD and LHS were restricted to countries with lower prevalence of scores &lt;\u20097.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Significant differences exist in the prevalence of low Apgar scores across countries. Their interactions with adverse outcomes demand caution when using the Apgar score in prognostic models for clinical care and research without local validation. More broadly, our findings emphasise the importance of accounting for country\u2010specific effects in clinical assessment scores.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18291","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T08:38:37Z","timestamp":1752568717000},"page":"649-659","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Five\u2010Minute Apgar Scores and Its Prognostic Value for Mortality and Severe Morbidity in Very Preterm Infants: A Multinational Cohort Study"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4587-1734","authenticated-orcid":false,"given":"Harald","family":"Ehrhardt","sequence":"first","affiliation":[{"name":"Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine University Medical Center Ulm  Ulm Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soodabeh","family":"Behboodi","sequence":"additional","affiliation":[{"name":"Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology, OPPaLE Universit\u00e9 Paris Cit\u00e9 and Universit\u00e9 Sorbonne Paris Nord, Inserm, INRAE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf F.","family":"Maier","sequence":"additional","affiliation":[{"name":"Children's Hospital, University Hospital Philipps University Marburg  Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien M.","family":"Aubert","sequence":"additional","affiliation":[{"name":"Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical, Perinatal and Pediatric Lifecourse Epidemiology, OPPaLE Universit\u00e9 Paris Cit\u00e9 and Universit\u00e9 Sorbonne Paris Nord, Inserm, INRAE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"\u00c5den","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S.","family":"Draper","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Gudmundsdottir","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Siljehav","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm 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