{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:13:02Z","timestamp":1788351182561,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,5,7]],"date-time":"2019-05-07T00:00:00Z","timestamp":1557187200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate associations between Apgar scores of 7, 8, and 9 (versus 10) at 1, 5, and 10 minutes, and neonatal mortality and morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1\u2009551\u2009436 non-malformed live singleton infants, born at term (\u226537 weeks\u2019 gestation) between 1999 and 2016, with Apgar scores of \u22657 at 1, 5, and 10 minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Infants with Apgar scores of 7, 8, and 9 at 1, 5, and 10 minutes were compared with those with an Apgar score of 10 at 1, 5, and 10 minutes, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Neonatal mortality and morbidity, including neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia. Adjusted odds ratios (aOR), adjusted rate differences (aRD), and 95% confidence intervals were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with infants with an Apgar score of 10, aORs for neonatal mortality, neonatal infections, asphyxia related complications, respiratory distress, and neonatal hypoglycaemia were higher among infants with lower Apgar scores, especially at 5 and 10 minutes. For example, the aORs for respiratory distress for an Apgar score of 9 versus 10 were 2.0 (95% confidence interval 1.9 to 2.1) at 1 minute, 5.2 (5.1 to 5.4) at 5 minutes, and 12.4 (12.0 to 12.9) at 10 minutes. Compared with an Apgar score of 10 at 10 minutes, the aRD for respiratory distress was 9.5% (95% confidence interval 9.2% to 9.9%) for an Apgar score of 9 at 10 minutes, and 41.9% (37.7% to 46.4%) for an Apgar score of 7 at 10 minutes. A reduction in Apgar score from 10 at 5 minutes to 9 at 10 minutes was also associated with higher odds of neonatal morbidity, compared with a stable Apgar score of 10 at 5 and 10 minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In term non-malformed infants with Apgar scores within the normal range (7 to 10), risks of neonatal mortality and morbidity are higher among infants with lower Apgar score values, and also among those experiencing a reduction in score from 5 minutes to 10 minutes (compared with infants with stable Apgar scores of 10).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l1656","type":"journal-article","created":{"date-parts":[[2019,5,7]],"date-time":"2019-05-07T23:59:05Z","timestamp":1557273545000},"page":"l1656","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":76,"title":["Association between Apgar scores of 7 to 9 and neonatal mortality and morbidity: population based cohort study of term infants in Sweden"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1273-0110","authenticated-orcid":false,"given":"Neda","family":"Razaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Cnattingius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KS","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,7]]},"reference":[{"key":"key20190509000323_ref1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-195301000-00041"},{"key":"key20190509000323_ref2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308458"},{"key":"key20190509000323_ref3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k207"},{"key":"key20190509000323_ref4","article-title":"1 and 5-minute Apgar scores and child developmental health at 5 years of age, a population-based cohort study","author":"Razaz","journal-title":"BMJ Open"},{"key":"key20190509000323_ref5","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12368"},{"key":"key20190509000323_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61135-1"},{"key":"key20190509000323_ref7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102153440701"},{"key":"key20190509000323_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12360"},{"key":"key20190509000323_ref9","first-page":"65","article-title":"Low 5-minute Apgar score: a population-based register study of 1 million term births","volume":"98","author":"Thorngren-Jerneck","year":"2001","journal-title":"Obstet Gynecol"},{"key":"key20190509000323_ref10","doi-asserted-by":"publisher","DOI":"10.1590\/S0104-42302012000500017"},{"key":"key20190509000323_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/1476718X13515425"},{"key":"key20190509000323_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.123745"},{"key":"key20190509000323_ref13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-9-14"},{"key":"key20190509000323_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/fn.86.1.F16"},{"key":"key20190509000323_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2006.05.009"},{"key":"key20190509000323_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(01)00456-0"},{"key":"key20190509000323_ref17","unstructured":"Swedish National Board of Health and Welfare. The Swedish Medical Birth Register: a summary of content and quality. 2003."},{"key":"key20190509000323_ref18","unstructured":"Swedish National Board of Health and Welfare. The National Board of Health and Welfare. The Swedish Medical Birth Register. A summary of content and quality. 2014."},{"key":"key20190509000323_ref19","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-450"},{"key":"key20190509000323_ref20","unstructured":"Swedish National Board of Health and Welfare. Quality and content in the Swedish Patient Register. 2013."},{"key":"key20190509000323_ref21","unstructured":"Swedish National Board of Health and Welfare. Causes of death. 2013."},{"key":"key20190509000323_ref22","unstructured":"Statistics Sweden. Evaluation of the Swedish register of education. 2006."},{"key":"key20190509000323_ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0117-y"},{"key":"key20190509000323_ref24","unstructured":"World Health Organization. Global Database on Body Mass Index: BMI Classification."},{"key":"key20190509000323_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.01.008"},{"key":"key20190509000323_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2006.05.040"},{"key":"key20190509000323_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38117.665197.F7"},{"key":"key20190509000323_ref28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1984.tb04168.x"},{"key":"key20190509000323_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.05.035"},{"key":"key20190509000323_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-018-0445-1"},{"key":"key20190509000323_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.adnc.2006.04.008"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l1656","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l1656","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T21:01:41Z","timestamp":1601067701000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l1656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,7]]},"references-count":31,"alternative-id":["10.1136\/bmj.l1656"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l1656","relation":{},"ISSN":["0959-8138","1756-1833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,7]]}}}